Hogar de las Madres

Yesterday, we got one more essential checked off our list: the clinic visit.  Obviously, we don’t want to actually have our kid at the clinic, but if complications come up and we have to transfer, the doctora prefers that it not be a completely alien environment. It also gave us a chance to jot down their prices, check out acceptable payment methods (yes, they do take Visa), and figure out where exactly the place is. It seems clean and un-intimidating. I’m guessing part of that is because the maternity hospital, while it has some association with the big hospital next door, is a physically separate facility. I’m not sure why you don’t see these in the US– you’d think it would really cut down on the cross-infection rates for ugly things like MRSA, if they just kept the maternity patients (i.e. the not-sick people) completely separate from the regular patients.

One thing that stunned us was how cheap medical care is. When we priced it out back in Maryland (my job included good insurance, but getting pregnant meant quitting my job), it would have cost us a bare minimum of $6,000 USD for a totally natural childbirth with no drugs, no emergencies, and no interventions, at the nearest small rural hospital. And compared to the swanky hospitals around Annapolis, DC, and Baltimore, that was a darn good deal. An emergency C-section at any of those hospitals can easily run you into the $20,000 range. If that had happened, our finances would have been completely wiped out, and we’d have been in debt for the first time in our lives.

At the Hogar, natural childbirth runs about 1300 soles, which is less than $500 at the current exchange rate. This includes a 2-day stay in the clinic to recuperate. You can pay a little more to get a private bathroom and cable TV. A Caesarian costs about 2500 soles: just under $1000, including three days’ recovery in the clinic. I am told you can have your kid at the hospital itself for even less– the only difference is that you spend your recovery time in a dormitory-style room with other women, instead of getting a private room. I’d still opt for the clinic, just because the place doesn’t have a hospital atmosphere, and hospitals really freak me out.

Still, we walked out of the Hogar’s office feeling a little stunned. In a clean, modern clinic in Miraflores, you can get a Caesarian section for less than one sixth of what it would cost you to birth a baby without any drugs or surgery in a rural Maryland hospital.

This isn’t all roses, of course. Because C-sections are more profitable, many of the private clinics run C-section rates of 90% or more, which is scary. That’s why the midwife is our first choice, not the clinic. Knives and needles are not my thing. Still, with the prices, you have to wonder… is there a medical tourism niche for coming to Lima to have a baby? For people who go the elective/mandatory C-section route, it would be economically sound to take a few months’ vacation, fly to Lima, rent an apartment for a few months, have your baby, hire someone to help you for a month of recovery, and then fly back home. I’m confident you could do the whole thing, including airfare, for well under $20,000. If there’s not already a business that can arrange this for you, there should be.

Nighttime hot flashes + high morning blood glucose = dawn phenomenon?

I ran the hot flashes and high-ish waking blood sugar number by my Mom (the diabetes expert), and she says it sounds like the morning blood sugar may be coming down from a 3am spike. It’s a common occurrence in diabetics, known as the dawn phenomenon, where somewhere around 3am, for reasons not well understood, blood sugar can spike, even in the absence of food– though it can be more common if you eat something starchy before bed. The symptoms, she says, are waking around 3am, feeling too hot/sweating, need to urinate, thirst, and a cottony taste/feeling in the mouth– which describes my experience exactly. Some of that, like the need to urinate, can be written off as just being pregnant. Maybe not all of it, though. What does happen, is I wake up in the dark hours of the morning, kick off the covers because even the sheet is unbearably hot (even though my husband, who is usually the warm one, is still sleeping soundly under the blanket), then lever myself out of bed because I really, really have to pee, and then promptly down a glass of water because I am thirsty and my mouth feels/tastes nasty. And then I go back to bed and lie awake until at least 5am because I can’t sleep.

This morning, when I woke up, I remembered to check my blood sugar, but not until about the point where I was getting comfortable with the temperature again. Glucometer read 89. That’s a smidge higher than my normal fasting numbers, but still close enough to be ambiguous. I’ll have to see if I can catch it right when I wake up, next time.

Bite-Sized

My fasting blood sugar this morning was 91. That’s not dangerous, and a lot of people would be happy with that number, but it’s the highest fasting blood sugar I’ve ever measured on myself– ten points above normal– and I was really bummed out by it.  This is because I am a total sugar fiend and I’ve been cheating. Just a little. One of the nice things about candy here is that I can buy a bite-sized, individually-wrapped piece of chocolate (4g of sugar), or a tiny package of 12 Lentejas (the local version of M&Ms, 12g sugar) for 30-60 centimos at the corner tienda, or any newspaper stand.  When I have a major chocolate jones, I don’t have to buy a whole candy bar and risk eating the whole thing just because I have it.

On the other hand, the ready availability of “safe” serving sizes means I have been indulging more often than I otherwise would. We’re not talking sugar binge here, we’re talking about a bite of chocolate once every two or three days. In theory, this is not a problem. In reality, though, every little taste of sugar just makes me want a LOT more of it. Because I’m an addict. There are support groups and rehab for people who do this with alcohol or cocaine. Not so much for sugar. Anyway, what happens is that the occasional bite of chocolate leads to a day like yesterday, where I had a bite of chocolate, a bit more fruit than I should have (spaced out to avoid angering my glucometer, but still…) and then, finding ourselves twenty minutes early for our prenatal class….  a (truly delicious!) coconut macaroon from the bakery near the casa de nacimento.

None of these things put my blood glucose into the dangerous range by themselves. Numbers are ok at one hour and two hours afterward. But through channels I wish I understood, two hours after eating is not really the end of the story. The real story is that all day, I kicked at the boundary fence just a little at a time, and then this morning, I was dismayed that it had actually moved. Stupid.

3 Boticas, no Methergin

We hit up two more farmacias today, and checked off four more items on our list (nail brush, isodine foam and solution, and pH neutral antiseptic soap)… but still no Methergin.  I think we need to email the doctora and ask where we can find it.

I’m in the middle of typing up our information packet in English, so that the next expat couple won’t have to translate it, and so that we can be extra-sure that our birth plan is something both we and the doctora understand in the same way. It’s easy enough to get the gist of any given sentence, but typing it up formally, so that it actually sounds good… that is a little more difficult. It’s a good exercise for my Spanish.

The hunt for Methergin

Yesterday’s prenatal checkup and class went well. I’m finally–finally!– up to 60 kilos. Which means I’ve gained a whopping twelve pounds over my pre-pregnancy weight. First time I’ve measured above September’s 59 kilos. Current weight gain is still below the 25th percentile line, but at least it’s moving upward at a reasonable and healthy rate. Fundal height is still tracking just below the 90th percentile, so we are not worried as long as I don’t stall out or start losing again. I’m gaining roughly one pound a week right now, so if that trend continues…  maybe 19-20 pounds by 40 weeks? That’s still below the recommended 24-32 pounds, but not a disaster. The book, and the charts, though, seem to indicate that it’s normal for weight gain to level off after 36 weeks. If that’s the case, I’m looking at more like 15-16 pounds, which is pretty low.  We’ll see.

The appointment also gave us a chance to clarify a few things from our information packet. Sometime in the next three weeks, we’ll have to go tour the backup hospital. We probably won’t need it, but the doctora prefers that the place at least be familiar, if we have to transfer in an emergency. I also have to go get blood drawn again 😦    More importantly, we find that we do not actually have to hire an ambulance to wait outside the casa while I’m in labor. That’s just an option for people who want it. The hospital is only about three blocks away, so that seems like overkill to me.

However– and I really wasn’t expecting this– we do have to buy and bring along our own medical supplies for the birth. We went to the supermercado and the botica yesterday and got most of the items checked off the list, including sterile gloves, gauze, cotton, redoxon, vaseline, peroxide, alcohol, two litres of vinegar (for the tub), pH-neutral soap, and a sterile syringe. That last one was a surprise because A) in the US it is nearly impossible to just walk into a pharmacy and buy a syringe, and B) that needle looks huge! I really hope I won’t need it.

There are a few items on the list they did not have at the farmacia we visited. We still have to acquire: isodine foam, isodine solution, 1 ampule of Methergin (I think this goes with the syringe, in case of hemorrhage)(and seriously, any Joe off the street can buy this??), a sponge, a fingernail brush, thick knee socks, and protective bed towels (I have no idea what this means– chucks? regular towels?).

So far we’ve filled up most of one backpack with supplies. I guess we’ll take a second backpack with all the more household type stuff: changes of clothes for us, clothes , blankets and diapers for the baby, snacks, icons, etc. Still seven weeks until ETA, but only three weeks until “holy crap I could go into labor any time now”, so we really don’t have long to get our whole kit put together. It needs to be all ready to grab and go when we need it.

33 Weeks: Bloodbath Before Breakfast

I woke this morning from a vivid dream about my sister.  She was not aware that she was dead. I was trying to break it to her as succinctly and gently as possible. I explained, almost in one breath, how and when it had happened, and that her son, my nephew, was doing well, ten years old now, living with his other auntie. “He has your freckles” I added.  It was a lot to take in at once, and she was a bit stunned. And then I woke up.

It didn’t hit me until later, in the kitchen. I no longer have nightmares about the accident, but I still miss her. Next thing I knew I was sobbing over the dirty dishes. I went back to the bedroom to sob on my husband instead. After a minute he looked at me and said:

“Why is there blood on your face?”

At the same time, I wiped my nose on the back of my hand, and left a long red streak. I made a dive for the emergency roll of toilet paper by the bed. I’ve always been susceptible to nosebleeds, but pregnancy has made this three times as bad. Normally, the sudden runny-nose feeling alerts me and I can catch it before I drip on anything. But I’d been crying and assumed the runny nose was just a runny nose.  My husband was somewhat relieved. Apparently the combination of tears and smeared blood made it look like I was bleeding from the eyes.

We both looked like we had narrowly escaped a massacre: The shoulder of his T-shirt was soaked through with blood, along with the neck of my own shirt, with various smears and spatters on our arms and hands, my face, two pillowcases, and one of the bed-sheets (thank goodness I hadn’t made the bed yet!). We gathered up the laundry for a soak in cold water.  My husband can’t figure out how I can lose so much blood so quickly and not feel faint. I don’t know. It looks like more than it really is? Lots of practice? There are some days I am half-convinced the sporadic bloodletting serves some greater physiological good– maybe it’s my body’s way of ditching excess iron reserves.

I’ve heard about pregnancy mood swings, and the tendency to cry over any little thing, but…  mine don’t usually manifest as tears. I just get cranky and hypercritical. It’s been four years since the accident, and I hardly ever do this any more, so I can probably blame the hormones. But then, maybe it’s regular old grief. It would be nice if I could have a good cry without bleeding everywhere. Hormonal or not, I still miss her.

Posted in pregnancy | Tagged | Comments Off on 33 Weeks: Bloodbath Before Breakfast