Vacunatorio

This past Monday we had Gretchen's 4-month doctor's appointment (albeit a bit late considering she is a few weeks over four months) and she is progressing just fine.  She is now at 6.8 kilos (15 pounds) and 63 cm (24.8 inches) our little grower keeps packing on the pounds, which is exactly what we want her to do.

And here are a couple of the pictures I took on her actual 4-month birthday.  The first photo was taken just seconds before the entire outfit (minus the socks) was covered in spit-up.  Second photo was just too precious to leave out.  Notice the socks were spared.

Although I was excited to see how Gretchen was progressing, I was also dreading this checkup because it meant that she was due for another round of vaccines.  I am a complete pansy when it comes to shots of any sort, and although it has gotten better since I've gotten older, I still needed my college roommate to hold my hand when I got my flu shot every year at school (thanks again Jules!), and it's just as difficult to see my little baby get shots.  Jon and I are of the mindset that since we are technically living in a third-world country and taking our baby on long distance flights multiple times in her first year, we'll go ahead and trust the AAP recommended vaccine schedule.  Honestly, we would have done so anyways, but these reasons just seal the deal.

Since the last round of vaccines that Gretchen went through at 2 months, we have had a change (for the better) in our medical coverage.  We are now covered by local insurance, which makes my life overwhelmingly easier considering that I don't have to submit receipts to our insurance company back home.  But, as with any change, I was a little nervous about the new process, especially when it comes to vaccines.

The biggest difference between what I'm used to in the US and here is that vaccines are not commonly given in doctor's offices.  We actually chose our pediatrician because he administers vaccines himself in the office (and, obviously, we liked his way of practicing medicine, etc, etc).   Also, if we have the doctor administer the vaccines, we have to pay in full, in cash and then wait for an 80% reimbursement from the US insurance company.  We went through that procedure back in April and the vaccines ended up costing us close to US$75 after the reimbursement.  Compare that to this week, when the shots were free.  And no paperwork.  Sign me up.

So, after our appointment on Monday, Gretchen and I took a decently long walk to the Vacunatorio.  There are quite a few locations in the city, our doctor recommended Stamboulian (Barrio Norte, 4515-3000; Pacheco de Melo 2941) and it was as good as a place that gives shots can be.  Clean, short lines and friendly staff. And I'm no hypocrite, I got my flu shot at the same time so I can vouch firsthand for how gentle they were.  For the record, Gretchen was an absolute trooper, she barely cried and just needed some extra loving and cuddles that night.  All in all it was a fine experience and it was made even better by the $0.00 bill we received at the end of our visit.  Not only that, they gave us a voucher for free parking (if we had driven).  Instead, we dodged pile after pile of dog poop on Pacheco de Melo (seriously, it must be a common dog walker route or something, it was intense) and walked home on a beautiful 60 degree night in the dead of winter here.  See you in 2 months, Vacunatorio, for the next round of vaccines! 

Buenos Aires Birth Day

As promised, I am going to weigh in on what it was like to have a baby here in Buenos Aires. Let me spoil the ending by saying that it was a very good experience. As with my Pregnancy Abroad post I have to preface everything by saying that everyone's birth is different, and I am only speaking from personal experience, not as a blanket statement about birth in Argentina.

To start with, we go through the private health care system in Buenos Aires (as opposed to the social medicine available to Argentine locals) and we have kept our US health insurance as expats. What this means for us is that we pay for all of our health care related services in full and then send the receipts in to our insurance company for reimbursement. It takes a little extra organization, but the process is pretty straightforward and we have yet to have any big issues with receiving reimbursement.

As far as the "players" involved in Gretchen's birth, my doctor, midwife, an anesthesiologist, a few nurses, a neonatologist and my husband in the room when I gave birth. I had never considered working with a midwife when I thought about my "birth plan" but my doctor routinely works with a midwife and we never really explored the option of going without. In the end, I really liked the way this tag-team approach worked, I called the midwife when my water broke and she took care of me up until it was time to push. This arrangement helps to ease the demand on a doctor in a single practice, there is no way he can be by the side of each patient during labor. Also, considering that they work together for the vast majority of the births they attend, there is no power struggle or conflict of interest between the two, they come as a team.

Aside from that, here are some highlights from my pregnancy:

Appointments:

• During the 1st trimester, I saw my doctor at least once every three weeks. During the 2nd trimester, the visits reduced to once a month and in the 3rd trimester we had appointments every two weeks. At 35 weeks we saw the doctor weekly. Every appointment included a full exam, an ultrasound and a non-rushed conversation with my doctor. He outlined what was going on now, what to look for before the next appointment and answered any questions or concerns Jon or I had.
• Over the course of my pregnancy, I had four full blood work appointments. Each of these appointments were at a location separate from my doctor's office and I needed to return to the blood lab pick up the results. For each of these appointments they did a urine workup, which involved me going to the pharmacy to purchase a sterile cup and then bringing my "sample" in with me to the appointment. (If only the taxi driver knew what was in the bag...)
• I visited a different doctor's office for Doppler ultrasounds four different times during my pregnancy, at 12, 20, 27 and 34 weeks. At three of these ultrasounds they printed out 3D/4D photos for us to keep and at the 27 week appointment we went home with a DVD of the ultrasound.
  
• Starting at 36 weeks, I began going in for weekly "Monitorio Fetal" tests (Fetal non-stress tests). This is basically an EKG for the baby. Each appointment requires a doctor's prescription and took place in a separate location from my doctor's office. (Coincidentally, I only ended up having one of these tests before I went into labor.)
• My doctor strongly recommended that I take birth classes given by the midwife he works with. These classes were 2 hours long, once a week for nine weeks. I found them helpful in that I got to know my midwife ahead of time, she knew who I was (and my level of Spanish) and they sold some great breastfeeding clothes at the class. Other than that, the information was mostly things that I had read in books or heard from my experienced friends, I think the time may have been better spent in one or two private sessions with the midwife.

**These appointments were required by my doctor, even without any risk factors or health concerns for the baby.

The Hospital (Sanitario de la Trinidad, Cervino 4720, Palermo):

• The hospital did not offer any public tours, however we stopped in without an appointment and were given a impromptu tour of both types of maternity rooms.
• The maternity options were all single occupancy rooms, either a "single" room or a "suite". The suite was $300 pesos additional per night and included a couch-bed for a guest to stay the night, a mini-fridge with drinks and light snacks, wi-fi internet, a haircut and ear-piercing for the baby (if requested) and daily newspaper delivery.
• For parents that possess an Argentine marriage license, twice a week the hospital has staff on hand that can process the paperwork for your new baby's national identity document (DNI). (For those that were married outside of Argentina, us included, you need a separate appointment at a government office. More to come on this process as we work through the red tape.)
• Although my midwife also works as a lactation consultant, there are a team of lactation professionals on hand at the hospital that checked in with us daily. They also provide in-home services for after you are out on your own.
• The check-in and check-out process were painfully slow. This is my only complaint about Trinidad, it was a multi-hour process from when we decided that we were ready check out to when we were actually able to leave. Thank goodness my labor wasn't very intense when we were checking in, that took a good hour as well. This could be attributed to the fact that we do not have local insurance, so the hospital had extra steps to take to make sure we could pay our bill. Either way, it was unnecessarily drawn out and a source of frustration.

The Birth

• We corresponded with our midwife to meet at the hospital and get checked in. She arranged for our reservation at the hospital, met us there and guided us as to where to store our things, and stayed with us from the lobby to the pre-labor room to the delivery room.
• Immediately after Gretchen was born she was put on my chest for a few minutes of bonding before anything else. Jon accompanied our baby and the neo-natologist to another room to be bathed, weighed and checked. This particular hospital does not have a nursery, so after that check we were not separated from Gretchen for the remainder of our hospital stay.
• The delivery room had strict regulations, only one person besides the patient (in our case, my husband was the chosen one) and no cameras/pictures.
• We stayed in the hospital for 2 nights/3 days for a natural (non-cesarean) birth. We were given the option to stay for an additional night if we wanted, but we were ready to get home.
• The visiting hours for the maternity wing were a total of 8 hours during the day. Outside of those hours, only one person is allowed in the room. This means that if your husband/partner is with you and the baby, no one else can come in.
• The hospital has a team of neonatologists on hand to examine your baby and monitor their health during your stay. Unless you specifically request it, your pediatrician does not come to the hospital as is customary in the US. If there is a health issue with your baby that persists after leaving the hospital, the neonatologist will contact your pediatrician and work together to transfer care. It is your responsibility to contact your pediatrician to arrange for your baby's first exam appointment or provide the neonatologist with the pediatrician's contact information, be sure to have this information with you when you check into the hospital.

That about sums it up for our birth abroad. We felt comfortable that if there had been an emergency situation, I would have been well cared for and would not hesitate to recommend having a baby in Bs.As. I am no expert, but I am happy to answer questions about my experience should anyone be interested.

And now a look at the result of our birth abroad, our little porteña:

Has a child ever been this precious??