We moved to Bogota when I was around 28 weeks along. I was kind of scared to give birth here in Colombia: not because I doubted the quality of care that I would be receiving (unlike the advice that I got from several non-Colombian family members who had never been to Colombia, at least not in the last few decades) but because I was worried about the high C-section rate prevalent among private hospitals. We decided that we would meet with the OBGYN, Dr. Alfredo Ruiz Rivadeneira, that my cousin had recommended to see if he seemed like the pushy doctor who valued his time more than my and my baby's health.
And then, he says to me, "You have really great tone! Do you exercise? Your stomach skin looks really great for how far along you are! Do you see her belly button? (he looks over to my cousin) It hasn't even popped out yet!" I felt my chest swelling (from pride, not pregnancy). I was doing yoga 3-4 times a week and walking as much as I could. I wanted to maintain my activity levels to the dismay of my Colombian family, who thought that I should be taking it really easy. After so much flattery, I didn't want to interview other doctors.
I loved being pregnant and giving birth in Colombia, but there are some striking differences to being pregnant and giving birth in the United States.
- You're basically treated like royalty on public transportation. On Transmilenio (the train/bus hybrid here in Bogota) and the SITP buses, they have special sections of blue chairs that are reserved for the elderly, people with disabilities, pregnant women, and women or men with children. Whenever I would step on and it was super crowded, several people would start calling out, "A seat, please! A seat! A pregnant lady needs a seat." It was awesome. I was always assured a seat even at the busiest times.
- I know a lot of women from the States who struggled with their weight gain while pregnant. They also struggled with the comments that came from that weight gain, like, "Eating for two, are you?" Here, I experienced something very different. People were telling me that I needed to eat more, that they were worried that I wasn't going to be healthy enough for the remainder of the pregnancy, that I should be gaining more (even though I gained 25 lbs, an appropriate gain according to my doctor and midwife).
- A woman exercising into her 3rd trimester is looked upon with awe and respect in the States (During my first pregnancy, I was one of those pregnant women who sat at home, eating Chipotle and snarfing down Shivers malt shakes, gawking over pictures of other pregnant women working out at 36 weeks and feeling sorry for myself). Here, I was told to be careful, not to climb the stairs too much because the baby might "fall out;" not to carry heavy things (like grocery bags); and definitely not to lift my 3-year-old son lest he squash the unborn fetus inside of me. What this meant was that I had several people (mostly men) holding my bags, opening doors, hailing cabs, etc for me. I felt all sorts of stares while walking down the street in my modified yoga clothes and running shoes, hurrying along on my way to pre-natal yoga class.
- The abundance of plastic surgery here, especially post-partum plastic surgery, is quite surprising. I secretly think the reason that many women in Colombia stick to the 40-day confinement period is that they run off to get liposuction right after the birth. I kid, I kid. Maybe. I mean, I can understand taking it easy for 6 weeks, but the looks I would get when I walked out and about with Roman at 1 week postpartum were that of horror and shock.
- C-section rate in private hospitals is above 90%. The WHO says it should be at around 33% and performed only when the mother or baby's health demands it. I think it might be a class distinction issue, where women who can afford to have a C-section will have one. I asked my cousin why she chose to have a C-section and she said that 1) she was too scared of the pain of labor and 2) it was less damaging and less traumatic to the baby to be born that way. Not sure if that's what the doctor told her, but I kept my mouth shut since she had already had the baby. If she does get pregnant again, maybe I'll forward her some articles about why the labor process is important and why opting to have a C-section is not a good idea.
- As soon as I checked into the hospital, everyone assumed I was going to have a C-section. After the split second pause that comes after I tell them I'm having a vaginal birth, they ask if I had already met the anesthesiologist, assuming that I had chosen to get an epidural right away. I said that I had not because I didn't want an epidural right away. There was a flurry of activity and murmuring while they ushered me into the staging area.
- In private hospitals, women labor in small rooms adjacent to the delivery area. Children are not allowed to be in the rooms with you, so we had to find a person to look after Desmond while I labored. Until recently, husbands/boyfriends/partners weren't allowed in the rooms either; Billy had to sign a form that said that he wanted to be with me while I labored. When I was ready to push, they wheeled me from the small room across the hall into the delivery room (which is basically an operating room). When you are done, they take your baby away (to give him his first vaccine, clean him up, clothe him) and they send you to your room. This was the part I hated the most: I waited almost 45 minutes to have him given to me. In Utah, I labored and delivered in the same room. I had access to a tub and went 24 hours without the use of an epidural. This would not have been possible in this hospital, since you were basically confined to the bed that took up most of the space in the small labor room. You wouldn't be able to easily walk around during labor and forget about using alternative methods of pain management. Here, they basically confine you to your bed in a diaper, attached to a saline drip. Also, in Utah, I was able to hold my firstborn after they sucked the meconium from his nose and mouth. We were able to have skin-to-skin contact the whole time I was in the hospital. The Colombian nurses chided me for not putting Roman in several layers plus a blanket. I'm not sure if they think that skin-to-skin is important only for preemies or what, but they never recommended it.
- They did heavily recommend and provide support for breastfeeding. This made me happy. No formula was allowed in the hospital and if your baby really needed it, you needed a special prescription for it from the pediatrician. There were lactation consultants that visited me every day of my stay.
- The nursing staff was so amazing. They were super nice and gentle and tried not to wake me up too many times during the night. They let me sleep with Roman in the same bed with me.
- During the whole pregnancy, I had my doctor's personal cell phone number. I felt comfortable calling him at any time (only did so once when I had intense contractions at 36 weeks). He was always available to me and I always felt really important, not just like another patient, but like a member of his extended family.
- Finally, the biggest difference between being pregnant in the States and being pregnant here was cost. In the US, we had health insurance and we still had to pay around $6000, including copays for midwife visits, for a normal vaginal birth. Our cost for the birth and doctor's visit in Colombia (we paid for everything out of pocket since we had no maternal health coverage): $2100.