For those who think that getting pregnant is just about conceiving and waiting for the right time to give birth, they are completely mistaken! The obstetrician is one of the key elements for everything to go well, and for you to have a peaceful pregnancy. Through them, your main questions will be answered, such as symptoms, what should and should not be done during this period, as well as, of course, following every step of your pregnancy development.
It is through the experience of the obstetrician that potential problems are detected even before they occur. With the help of additional tests, they can assess all situations related to your pregnancy, as well as every detail of your health and your baby’s.
For this reason, you need a professional you trust completely, someone who won’t just write down basic information in your pregnancy record, but who will really commit to caring for you closely until delivery, paying attention to every detail throughout your entire prenatal care.
Ways to Choose
To do this, the best way to choose the obstetrician to monitor your pregnancy is through recommendations from friends, family, and acquaintances. Of course, what is a dream for your neighbor may not be ideal for you. With doctors—especially obstetricians—you need to feel comfortable, secure, and everyone has their own unique requirements.
Some women prefer to see male obstetricians, finding them calmer, more patient, and attentive during appointments. Others prefer female doctors, as they fully understand how they feel and women tend to feel less embarrassed during consultations.
References
Looking for references on the internet is also a way to gather information and read about possible complaints. You can check a doctor’s qualifications and specializations, as well as their affiliation with hospitals and universities. If your doctor is associated with the Brazilian Federation of Gynecology and Obstetrics Societies, even better.
Also, keep in mind that not all gynecologists you trust are obstetricians, as some have not specialized in this field and may refer you to others. And finally, have a consultation with them to draw your own conclusions. Ask questions, clear all your doubts, including regarding their care and 24-hour availability.
Check if they provide all their contact details so you can get in touch if necessary—after all, pregnancy is full of surprises and you never know when you’ll need help. This availability from some doctors makes all the difference for pregnant women and their families! If you do not feel confident and well cared for, seek another obstetrician without a second thought.
Private Delivery vs. Public (SUS) Delivery
A topic that greatly concerns pregnant women is delivery, especially for those without health insurance. The fear of not receiving adequate and quality care at the most precious and important moment of your life is understandable, especially since we so often hear about errors and negligence in maternity care.
If you opt for delivery through SUS (the public health system), it’s important to know which hospital you’ll deliver at, as well as all the necessary information about admission and companions. Through SUS, the main focus is for all women to give birth vaginally, and cesareans are only performed when truly needed, so be aware of these conditions.
Private Delivery
Many women—even those with health plans—end up avoiding “cesarean-only” doctors in their network so they may have a desired vaginal birth through SUS. If you want a private delivery, seek references from friends who had their babies recently too. If you will pay for delivery, ask questions about the care you will receive and the private obstetrician’s availability, as well as whether someone will cover in case of their absence.
Check the maternity wards they work at and find out which ones they are affiliated with so you can visit them before the birth. Researching costs is also wise, as we know some charge unrealistically high fees.
Whether your baby is born at a private hospital or through SUS, your baby’s birth must be a unique and special moment for you and your family. Weigh the pros and cons and always do what is best for you, respecting your desires and rights as a pregnant woman and, above all, protecting your health and your baby’s.
Every pregnant woman deserves respect, care, and medical attention whenever needed, as well as free prenatal care at every health center in Brazil. There are those who love public births, those who dread them, and those who have no choice but to face them and demand their rights and respect above all else!
Women’s Rights During Childbirth – Obstetric Violence
Today I am pleased to welcome Daiana Barasa, who is here to talk more about and clarify what constitutes obstetric violence, an issue still rarely discussed among mothers and mothers-to-be. It is important that everyone knows that unfortunately, this kind of practice still exists to this day and is becoming increasingly common. Welcome, Daiana, especially with such an important topic!
“Being a mother is truly a gift worthy of reverence, praise, and tribute… but on our planet, the reality is masked by hypocrisy. I recently saw a public service campaign in Uruguay that denounced the abuses women suffer during childbirth—the video went viral, even winning an award at Cannes—but the story repeats itself in many places worldwide.
In the Uruguayan campaign, the message was: if a woman “spread her legs” to make a child, she must be “brave” to get seen faster and be “brave” to be disrespected. Shameful!
This commonly practiced and hidden violence is known as obstetric violence. According to data collected in March this year by the Grupo de Maternidade Ativa (GAMA), between 80% and 90% of Brazilian women are cut (undergo episiotomy) during vaginal birth procedures, without need and without the woman’s consent.
For the Federal Prosecutor’s Office, such reports clearly constitute violence against women, and, according to the agency, health institutions that disrespect women giving birth—or their right to contact and breastfeed their baby right after birth—should be reported so they can be properly punished.
But what punishment could give a woman back the respect she should have had at that “one, unique” moment? Before the tributes and praise to women who bring life, it’s important to think about what happens in our country and around the world.
International Amnesty Campaign from Uruguay:
Are the complaints known by the Federal Prosecutor’s Office enough for effective action? Or should women be aware of other incidents besides their own so as not to allow these acts of disrespect to be imposed on them as an “obligation”?
Yes, because if you “spread your legs” you have to withstand every kind of humiliation by health professionals who should at least show respect for women. And how long will women remain passive, indifferent to knowing and understanding the laws that protect them? How long will they remain unconcerned with laws that have yet to be created or enacted on their behalf?
Obstetric violence is practiced in many public hospitals in Brazil and worldwide—and let’s not think it does not happen in private hospitals, for even cold, dismissive, and curt answers from health professionals are also a concealed form of violence, which could be overt if the physical conditions were less sophisticated.
Once again referencing the award-winning campaign by Amnesty International in Uruguay, which received millions of views and applause at Cannes, I ask: What prize did or will the women who suffered or will suffer obstetric violence receive?
Where is the praise for motherhood when being a mother is literally “suffering” where there should be paradise? Which is the worse violence—the one suffered by women during childbirth all over the world? Or the “self-violence” when women lack knowledge or do not fight for their rights?
Spreading your legs shouldn’t be a reason for humiliation during birth around the world, but before that happened, arms were folded and eyes were shut. Being a mother is a gift, yes, but women must recognize their right to be women and must not be silent. www.saredrogarias.com.br
And as a research source, used the State Public Defender’s sites of São Paulo:
http://www.defensoria.sp.gov.br/dpesp/repositorio/41/Violencia%20Obstetrica.pdf
The importance of reporting cases of obstetric violence: http://g1.globo.com/sp/sao-carlos-regiao/noticia/2014/04/denunciar-violencia-obstetrica-e-o-1-passo-para-reduzir-casos-diz-medica.html
Testimony of Obstetric Violence – Daniela
Below is reader Daniela’s account of the obstetric violence she experienced when she needed a curettage. But after all, what is obstetric violence? In contrast to humanized birth, which prioritizes the wellbeing of mothers and babies, obstetric violence is not just about physical aggression.
How can such a beautiful moment as childbirth turn traumatizing due to humiliating, disrespectful, and rude treatment from the professionals caring for the patient? Verbal abuse often hurts more than a slap.
Any treatment that is inappropriate for the situation can be considered obstetric violence. For instance, if a woman is struggling to push during labor, she should not be tied down or prevented from screaming, nor should she be sworn at with things like “shut up and push this child out”, or have procedures done without her prior consent or at least an explanation.
Anyway, obstetric violence cases are being reported more often because fortunately, people are becoming increasingly aware of their rights, especially pregnant women.
“My case of obstetric violence did not reach the delivery room, actually it was far from it… After just two months of trying to conceive, I got a positive test—my husband and I were overjoyed, told our family, and started celebrating until, at the 7th week, during an ER visit for light bleeding, we were devastated to learn our embryo had died.
I’d already heard its heartbeat at a 5-week ultrasound, so it was incredibly shocking to see it no longer beating, and to see the sadness on my husband’s face, as he was with me hoping to see and hear our baby’s heartbeat for the first time…
I saw the ER doctor, who explained that I had an embryonic demise and would need medication for seven days to complete the miscarriage, then return to check if it was done and if I’d need a curettage.
She was professional but detached, gave me a seven-day sick note and clear instructions, so I went home to face the pain and emptiness of losing my baby. It was very painful and my husband and I were inconsolable, but life had to go on.
Two days after starting the medicine, I had strong contractions, and after bleeding began, I finally expelled the embryo—an overwhelmingly sad moment, above all for what it represented: I knew my baby was dead and would have to leave, but seeing it come out of me, falling into the toilet, was excruciating. I bled a lot for the next few days, then, at the end of the week, returned to the ER, where I first had an ultrasound then saw the on-call OB.
In the gynecology waiting area were other happy pregnant women caressing their bumps and a worn-out woman in active labor, while I clutched my scan to see if my uterus was empty of all the baby I’d expelled.
I tried to hold back tears, hoping I wouldn’t need curettage since I knew if I did, I’d have to wait at least six months before trying for another baby—which, of course, would drive me crazy in my anxiety…
When it was my turn, I noticed a lot of trainees and/or residents in the room and an older doctor who seemed to be in charge. I was a bit lost and one of the professionals asked about my case, everyone watching me.
I answered, intimidated, that I’d been diagnosed with embryonic demise, had taken medicine to expel the embryo, and was there so they could confirm the expulsion was complete. I’m not sure if anything I said was confusing or came out wrong. The older doctor took my ultrasound, gave directions to the others, and left.
Then, the staffer told me there were still retained products in my uterus and I’d be given another week of medication to try to empty it all.
I asked if I’d get another week off work since the medicine causes cramping. The staffer looked very unwilling and said: “I’m only going to give you today, I can’t give you more than that”. I was desperate since I was in no physical or emotional state to return to teaching: the blood loss had left me weak, and memories of the miscarriage made me cry constantly.
I began to cry and said, “I can’t go back to class, I teach standing till 10pm, I just won’t make it…” The doctor seemed very irritated and replied, pointing to a colleague who was writing the note: “She’ll see what she can do for you” while she wrote the prescription. She handed me a prescription and sick note, saying, “We’ll give you two days, no more than that.”
I thanked her, wiping tears away, leaving the room confused, not understanding why I had been treated so carelessly and contemptuously. I was a victim, losing my baby, I’d come to the ER hoping for compassionate, human, sensitive care and, instead, was met by people who clearly believed I was using the miscarriage as an excuse not to work.
I was left with many doubts, trying to remember what I’d said that might have seemed ambiguous or led to misunderstanding to justify the doctor’s harshness…
But I couldn’t find any reason. At home, sharing what happened, some people said many doctors assume miscarriages are induced and so act coldly or rudely toward their patients.
It hit me that this is exactly what happened to me—that doctor believed I’d caused my baby’s death and that’s why she was so cold and harsh.
I cried a lot when I realized this, felt deeply offended and hurt, regretted not being ready to stand up for myself in the moment, for not having responded, for not demanding my rights, for begging for another day’s leave, for being misinterpreted and judged so inhumanely at such a painful time.
The biggest trauma of my miscarriage was not the loss itself, but how I was treated in the gynecology room, by professionals so insensitive and inhumane. To think that medical residents are being trained this way is revolting. I believe a doctor should treat all patients professionally and impartially, regardless of their own biases or judgments.
I believe even women who induce abortion have a history of pain and suffering, and no woman should be judged by appearances at such a moment, but given proper medical care and guidance. Doctors are doctors, judges are judges.
I have since been attended by the same doctor during my second pregnancy—she was polite and professional, but I can’t help but shake and feel nervous as soon as I see her. She always reassures me, “Everything’s fine with your baby, don’t be nervous,” but I can never explain that seeing her face is what makes me anxious, recalling her neglect.
A few months later, a friend had a similar experience at another ER with a different doctor, but I had warned her and she reacted accordingly: “Listen, you don’t know me, know nothing about my story, you have no right to judge me! I am grieving a deeply wanted baby, and not killing—it’s not for you to judge by appearances, you’re a doctor here, stick to treating me,” and so on.
My dignity felt a little restored by my friend’s reaction, but I will always bear the frustration of not having stood up for myself when cornered and intimidated by those who should have supported and comforted me.
Do you know of any obstetric violence case? Then contact me so we can add to this very important topic that must be discussed and clarified for its importance. Share, comment, and spread this story!
Letter from a Mom to Her Gynecologist Obstetrician
Doctor, When I realized I was expecting a baby, I felt that life was blossoming in the most blessed way in my life. So this moment could happen in peace, we always look for some angel, a gynecologist-obstetrician that God sent to help new life come into the world with health, for everything to go well for mother and baby.
But Doctor, lately there have been so many professionals who ruin this beautiful moment… Not to mention the bad ones, who care more about the money they’ll make than their patient’s health. There is a huge gap in compatibility and respect when it comes to ideas about how the delivery will happen, so trust has been shaken day by day.
There are so many misunderstandings between mother and doctor, no matter how much trust the professional inspires. I am realizing that there is always a mismatch in ideas and this can damage the patient–gynecologist-obstetrician relationship. Why does it have to be like this? For me, ideally, your gynecologist should be your best friend, especially in the final stretch of pregnancy, which is when we feel most vulnerable and fragile!
Whenever we need support or comfort, we turn to the doctors who care for us, Doctor—our safe haven where we want to rest and entrust what is most precious. Birth is a unique happening and we want to be surrounded by love and understanding, not just by a cold, strictly professional environment, devoid of human warmth. Affection is so necessary at this time; it comforts, embraces, and adds magic to the moment.
Humanity is being forgotten, especially in public hospitals that, even in natural vaginal deliveries, tie women down and also cut the perineum without her consent!
Humanity is lacking in many cases, but above all, passion for the profession is missing from many (not all, but a large number of) current doctors, who chose it for the financial return. The infamous “cesarean doctors”—forgive me, but inducing unnecessary c-sections is, to me, proof of greed.
You know, Doctor, I think that’s why there’s such a wave of home births and the cause of humanized birth is being so widely raised and embraced by women.
This is a sign of the lack felt by pregnant women of feeling protected and respected by the professional she chose for such a beautiful moment. Without proper respect for the chosen method of birth, without being able to have a say or be heard regarding any procedure that will happen during their delivery.
In the end, Doctor, what we really want is a successful delivery—a birth that is unforgettable and as healthy as possible! To hold our baby in our arms the moment they’re born, to see, feel, and love them as soon as they leave our belly. To breastfeed them as soon as they come into our arms…
Humanity is missing at the time of birth, and unfortunately, this situation seems far from ending. What, or who, will it take to restore respect and care to women’s birth choices? Is it right to force surgery on a woman in excellent health, who has always dreamed of a natural birth, without even trying?
I agree that a successful birth is when both mother and baby are healthy and happy, but there is a lack of compassion and a lot of professional egocentrism when the subject is “saving time.” What is best for mother and baby should prevail in 100% of cases, but that does not mean it must always be a forced elective cesarean, or an aggressive natural birth with the mother tied down throughout labor.
It’s enough to reflect a bit, to put yourself in the husband’s position or even in the shoes of the woman who has waited nine months for this moment. What does she want? This question alone can make birth as humane as possible, respecting the desires and limits set by the woman’s health or perfect health conditions.
It’s up to us women to choose the ideal doctor and insist, to those who do not respect this moment, that they change their mindset and start considering every woman’s wishes. To the good professionals, congratulations! To the bad ones, my condolences…
If you do not love being an obstetrician-gynecologist, if you’re only in this job for money and not love, I respectfully suggest you look for another specialty. All forms of birth and delivery are valid, what’s important is that it is done with respect. To humanize birth, we need to humanize professionals first.
Thank you for everything, Doctor. I hope my next birth will be as human as possible.
Patricia Amorim, mother of three, two necessary cesareans, one unnecessary but because of medical insistence, and still grateful to find in her third birth an excellent professional who made it all go well despite pre-eclampsia.
See Also: Letter from a Mom to Her Gynecologist Obstetrician
Photo: Prefeitura de Olinda
