Giving Birth in Portugal: A COVID-19 Odyssey
By: Shahnaz Radjy
Tags: Birth, Covid 19, Mothers And Daughters, Motherhood, Portugal

Giving Birth in Portugal: A COVID-19 Odyssey

Photo by the author. Can you tell I’m smiling?

What follows is my birth story. It isn’t short; it’s more of an odyssey.

Although I have shared this account with close friends a few times over, I have yet to find a way to tell it that does not sound dramatic, or make me sound like a victim — which I am not.

My birth story is presented in three sections below:

The birth plan

What happened: A chronology

How I experienced by birth journey

Note: I did not want to know the sex of the baby, which explains the use of pronouns below.

The birth plan

Since I learned I was pregnant, I was hoping for a vaginal birth without epidural. Having changed hospitals at 37-weeks pregnant to ensure a more humane experience that prioritized the first connection between mother and baby, it felt things were falling into place. Francois and I had taken a virtual course on hypnobirthing, a fascinating approach using meditation, relaxation, and breathing techniques to allow for a medication- and pain-free vaginal birth.

I hoped the baby would come by itself, without the need for a medical induction, as I wanted to honour the idea that babies know when they are ready. I also knew, and was comfortable with, Portugal’s policy recommending inductions at 41 weeks.

It’s true that births almost never quite go according to plan, but I still wanted to have an ideal to strive for. After years of being terrified of giving birth, it was living on a farm and seeing goats give birth what seemed effortlessly that inspired me to try and do the same. (You can read more about that here.)

What happened: A chronology

The due date, January 31, came and went. After that, the hospital had me come in every two days for foetal monitoring. Finally, we scheduled an induction for Sunday 7 February, the 41-week mark.

On Friday morning, my husband and I went for our COVID-19 tests, a thoroughly unpleasant experience made worse by the efficiency driving the two healthcare workers in full Personal Protection Equipment (PPE). They were going fast, so they were the opposite of gentle.

That same afternoon, Francois got a call saying he had tested positive.

He was asymptomatic. For the past two weeks, he had only gone out for groceries and to get new eyeglasses, respecting all the safety measures. So, on Saturday he went to get another PCR test, this time from a private lab. It came back negative.

On Sunday, I went to hospital as planned. I asked for a membrane sweep, postponing the possible induction to a day later, but the doctor I saw disagreed vehemently. She explained that I’d have to redo a COVID-19 test, and that she would mark my file to say I refused the induction. She clarified there was no plan of care past the 41-week mark — no more regular foetal monitoring visits or anything else, just me on my own, free to come in to be interned either for labour or an induction when I decided to do so.

While mild, that risk to the baby was not acceptable to me, so I accepted the induction.

As I was being interned, it dawned on me that not only could Francois not be there for this part of the journey — as far as the hospital was concerned, he was COVID-positive and had to self-isolate for 10 days — but I was going to be treated as high risk, which meant no one else could step in for Francois either. We had a close friend and a doula on call in case it was possible for either to join, but unfortunately, I was going to be alone for this birth.

I was brought to a windowless room tucked away in a corner that made it easy to cordon off as high risk. Anyone coming to see me, nurse or doctor, had to wear full PPE. There was almost no internet signal, just a “blip” every so often that barely allowed for WhatsApp messages to go through.

On Sunday at 11am I got my first induction measure, a vaginal insert. Over the next 48 hours, I got four additional medical nudges in oral form, and contractions started.

Every time a nurse or doctor checked in on me, they asked me to rate my pain on a scale of one to ten. Once I got to three, the automatic response was to ask whether I was ready for an epidural. I refused every time, as in my mind I would consider it only if the pain got to at least an eight and felt unmanageable.

By late Tuesday afternoon, I was at 2.5cm dilated. That was not much to show for the medication I had taken or the amount of time I spent having contractions! The doctor therefore recommended a C-section, and I accepted. I knew going in that the policy is to go for a C-section if induction doesn’t progress as it should, with three days being the upper limit for how long a woman can wait.

The doctors I had seen during my prenatal visits and the nurses I spoke to once interned all confirmed that my birth plan was in my file, that it was clear, and that it was supported by hospital policy. There was no question my preference was for minimal cervical checks, a vaginal birth with no episiotomy unless medically indicated, and no epidural* unless I changed my mind. The most important elements were that the baby be placed on me skin-to-skin right after birth and left there for as long as possible, often referred to as “golden hour”, so that s/he could crawl up to my breast and latch (yes, this is a thing!).

When I brought up the importance of golden hour with the doctor who would perform the operation, he hesitated and said it depended on the paediatrician. I insisted, saying it was important to me and could he please relay this.

The operating room (OR) I was taken to was COVID-ready, so everything was covered in plastic sheeting, and the minimal staff present was in full PPE. I got an epidural; the needle was inserted into my spine four times (I don’t think that is how it’s meant to happen — it wasn’t comfortable, but it wasn’t painful either), and I finally started feeling the pins and needles type tingling in my legs. The anaesthesia was working!

I asked twice whether the baby could be placed on me once born, and got vague answers like “if the circumstances allow it… we’ll see.”

Arianna Zoe Artemisia was born at 7:27pm on Tuesday 9 February.

My first glimpse of her was when they carried her by me — she was perfection, all chubby cheeks and purplish pink skin.

They took her to the back of the room to do the usual checks, and eventually brought her to me all bundled up, placing her on my left shoulder and eventually sort of placing her face on my right breast. I asked that they remove the sheet she was wrapped in so we could be skin-to-skin, and was told the baby would get cold. Once I clarified they could leave the sheets on her, they relented. It lasted maybe a minute.

The next time I saw my daughter was in the hospital room I was brought to after what felt like at least an hour.

Photo by the author. My favorite thing about that hospital room was the transparent crib on wheels (and the bundle of joy in it of course!)

In parallel to all this, they had said the operation should take 30–45min. I texted Francois just before I got taken to the OR and some three hours later, he called the hospital in a panic because he never heard back from me. Somehow, it was closer to four hours between the moment I got taken for the operation and made it back out.

I stayed in hospital four nights after birth. My new room had a great internet connection, its own bathroom, and two big windows. Medical staff still had to wear full PPE to come in to see me, which led to some challenges around the support I got: beyond the scheduled rounds and checks, nurses were reticent to come if I hit the “I need help” button. Instead, they came to my door and peered through the window to see what I needed before deciding whether it was “worth” suiting up to come in.

My take-away is that the already flawed healthcare system was further hindered by COVID restrictions. Breastfeeding was one area where I got support, but far from what was needed for me to have the tools and knowledge I needed to do it right.

But — and this is no small thing — we made it home healthy and happy, and ready to embark on life as a family of three.

How I experienced my birth journey

When Francois tested positive for COVID, my mind went blank. I couldn’t visualize what my birth journey might look like. I didn’t want to do this alone — ever, but especially not in Portugal and in Portuguese. Here, doctors are still very much not questioned and often don’t like to discuss or explain medical decisions. More than anything, I wanted to know I’d have someone in my corner, going to bat for me, and championing my preferences so that I could focus on my breathing and welcoming our child into the world in as harmonious and peaceful a manner as possible.

I also thought it particularly important for my husband to be there when our first child was born, to be with me, but also for the sake of his journey into fatherhood.

Once I registered that these preferences were moot, I steeled my resolve. This baby was going to make its grand debut one way or the other, and it was up to me to make that as smooth a start in life for him or her as possible.

All that to say that I threw almost all my expectations out the window, and decided to take what came in stride. The only exception was my fervent desire for that first skin-to-skin contact.

As a result, throughout the odyssey, I was ok. Better than ok — at peace, almost in a meditative state. I hit a few walls, cried a few times, but really, I was doing well. WhatsApp saved me, because despite the dysfunctional internet connection, it allowed me to connect with close friends and family across time zones who poured support through their screens and across airwaves.

The morning after the C-section, the nurse made me get up. It felt barbaric, and I almost passed out from the pain, but the tough love approach worked as I was mobile enough by the end of that day to get up and go to the bathroom as well as take care of little Arianna, breastfeeding and changing her diaper as needed.

In other words, although I would have loved having Francois there with me — for him, for the companionship and support, for the hands-on help — flying solo also showed me that I could do it all. Slowly and clumsily at first, but the bottom line was that as long as my daughter and I had each other, we would be just fine.

Three months on, I stand by that feeling, even though I am supremely grateful to be home and to have my husband to co-parent with.

Photo by the author. My daughter and I in the vegetable garden.

I have a whole lot more to say about the postpartum period, but that is a subject for another, or various other posts.

Thank you for reading this far!

If you have a birth story or breastfeeding saga you’d like to share, especially if you became a mother in Portugal, I would love to hear it. Please get in touch (sradjyATgmailDOTcom) or fill out this Google form.

*This is a personal preference and reflects zero judgement for anyone choosing to have an epidural as part of their birth plan.