This has to be one of the most difficult topics I’ve ever covered. Usually, I try to offer some concrete advice or a clear path forward for expats moving to Cuenca, but this time, there’s no neat ending. We’re still grappling with our own journey. It’s emotionally charged, too. Apart from my fiancée Michelle, I’ve never really opened up about the challenges we faced during the birth of our son in Cuenca almost three years ago. But with another baby on the way in just two months, it feels like the right time to share our story.
Fighting Against the System
What do I mean by “fighting doctors”? It’s a two-fold battle. On one hand, the entire process of trying to give birth naturally in Cuenca is a fight against a system that prioritizes doctors’ convenience and the industrialization of childbirth over the well-being of the mother and baby. It’s a fight with significant consequences for society.
On the other hand, I almost got into a physical altercation with doctors and hospital staff when our son was born. But more on that later.
The Shocking Reality: C-Sections in Cuenca
One of the most startling facts I’ve come across is that 90% of births in Cuenca’s private sector are by C-section. That’s an insane figure! Even if the real number is slightly lower, it’s still way too high. The reason? Convenience. Doctors can schedule the birth, and mothers are often given information that nudges them towards a C-section over a natural birth.
Michelle had previously given birth twice in Quito at a water-based natural birth facility. Those experiences were filled with love, care, and attention. In stark contrast, our experience in Cuenca was completely different. We wanted a natural birth at home, ideally in water like the previous ones, but finding a doctor, doula, or midwife willing to assist was nearly impossible. The legal landscape here complicates things, especially if you’re not part of an indigenous community.
The Birth Plan: Empowering Mothers
During our search, someone recommended we join a pregnancy circle led by an experienced midwife. This group was eye-opening. It focused on empowering mothers, preparing them for the birthing experience, and creating a birth plan. The birth plan is crucial – it outlines everything from pain management to who should be in the delivery room, and even how the mother should be positioned during birth.
However, the big question is how much of this plan hospitals will respect, given their own policies. In Ecuador, it appears that doctors often use laws meant to preserve human life as a tool for their convenience, rather than for the mother’s well-being.
Our Previous Birth Experience in Cuenca
When the time came for our son’s birth, we had everything ready for a natural home birth. But as labor progressed, it became clear that our baby wasn’t in the right position, and he refused to move. After hours of trying, we had to switch to Plan B – heading to the hospital.
The journey to the hospital was tough, especially as Michelle was fighting contractions. When we arrived, things went downhill fast. I was told I wouldn’t be allowed into the delivery room due to a sudden change in COVID policy. This policy change wasn’t communicated to us or even to our surgeon. I was livid as it was. I’m not sure how I would have reacted if I’d have known the real reason for not allowing me into the delivery room. Turns out they refused entry to ensure there were no witnesses just in case something went horribly wrong during the birth. A family was in the process of suing the hospital for a previous delivery and the hospitals response was to just remove witnesses and use the confusion around COVID as a cover.
It took everything in me not to physically lash out. I eventually calmed down, realizing that fighting wasn’t going to help Michelle or our baby.
The Emotional Rollercoaster
The next 20 minutes felt like an eternity. I sat alone in a room, ear pressed to the door, listening for any sign of progress. Finally, I heard the unmistakable cry of a newborn. It was my son – I just knew it. Moments later, I got a brief glimpse of him before the nurses whisked him away again.
It wasn’t until 30 minutes later that I was allowed into the recovery room with Michelle. She was weak, and it was clear she’d been through a lot. The surgery had complications, but thankfully, both Michelle and our baby were okay. The relief was indescribable. We named him William after my late grandfather.
Looking Forward: Our Upcoming Birth Plan
As we prepare for the birth of our next child, we’re still figuring out the details. The previous C-section complicates things, making it likely that we’ll opt for a hospital birth. We’re considering two hospitals: Clinica Latino, which offers a private room and some customization options, and Hospital Del Rio, which is closer to us.
We’re fortunate that cost isn’t a primary concern, but if you’re planning to give birth in Ecuador, make sure your health insurance covers pregnancy and childbirth. It’s essential to have coverage before becoming pregnant, or it will be considered a pre-existing condition, and you won’t be covered.
Final Thoughts: Taking Charge of Your Healthcare
This journey has been challenging, and I don’t have all the answers. There’s no neat ending here. But one thing is clear: you may need to take more charge of certain aspects of your healthcare when living in Cuenca – or anywhere, for that matter. The flip side of this challenge is freedom – the freedom to make choices that directly impact your life.
Ciao ciao!
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GIVING BIRTH (& FIGHTING DOCTORS) IN CUENCA – OUR BIRTHING EXPERIENCE (TRANSCRIPT)
Jason
00:00
This is the most difficult topic of cover to date in my videos. I do normally try to give some sort of concrete suggestions or path forward for expats thinking of moving to Cuenca or living here already, but this topic has no neat ending. We’re still struggling to find our own path forward.
It’s also very emotionally charged. Apart from my fiance Michelle, I haven’t really ever opened up around the very difficult birth of our boy in Cuenca almost three years ago. So here we go. This video is about our experience of giving birth in Cuenca. And plot twist, we’re due to do it all again in approx 2 months as Michelle is pregnant with our latest child
Vamos.
00:51
The original idea was to include Michelle in this video, but the last few days have just been very tough on her because of the pregnancy so it’s just not the right time. I will get to why it’s been tough in a bit, but I do want it to be clear that these are my thoughts and feelings. Michelle has her own perspective which I hope she can share with you at a later date.
So what exactly do I mean by fighting doctors? Well, I’ve got 2 meanings. The whole process of giving birth naturally in Cuenca is a fight.
01:21
It’s a fight against the current system that prioritizes the convenience of doctors and the industrialisation of giving birth over the outcomes of the mother and baby. It is a huge fight with enormous consequences for society.
I also mean fight in the physical sense, in that I did almost get into a physical altercation with doctors and hospital staff when our son was born in Cuenca. This is a bit later in the video, do feel free to skip ahead.
01:51
One of the scary takeaways from a discussion I had with Doctora Maité was that 90% of births in Cuenca’s private sector are by C-section. 90%. I still cannot believe that. It just sounds crazy to me. Feel free to check out that interview here. Maité is a fantastic GP with a holistic approach to medicine.
Regardless of whether the actual figure is 90%, it’s definitely way higher than it ought to be. The key reason seems to be convenience, doctors being able to schedule the birth and mums being fed information that effectively supports the C-section over natural birth. I had zero idea this was the case until we started looking around for natural birthing options in Cuenca.
02:43
Michelle previously gave birth in Quito twice in a water based natural birth facility. These experiences were filled with love, care and attention towards the needs of the mother and baby. This is in stark contrast to our experience with our son born in Cuenca. Our plan was to have a natural birth in our house, preferably in water like the two previous births. We searched long and hard for a doctor, birth duela or midwife to deliver the baby, with a surgeon on standby just in case. The search was intense and really quite difficult. Most doctors looked at us like we were outright crazy. There were significant legal reasons why they couldn’t help us. Unless you’re in an indigenous community in Ecuador, home births just seem to sit in this legal gray area.
03:35
Someone recommended us to try a pregnancy circle run by an experienced midwife. The focus of these weekly meetings was to prepare the parents for the birthing experience. In particular, it focused on empowering mothers of their rights when giving birth. This was an eye opening experience. The only real frame of reference for basically everyone in this group was how TV and movies portrayed the birthing process. You know it. The water breaks, rush to the hospital, push, scream a bit, push once more and out pops a screaming baby.
04:14
Turns out there is a lot more to it than that.
I’m extremely grateful for this circle as it focused on the human side of giving birth, in particular empowering the mothers to take ownership of their bodies and their birth experience. Central to this was the creation of a birth plan. This provides instructions to everybody involved about how the labor, birth and recovery process is to play out.
04:42
They generally cover the more obvious items like pain management, who should be in the delivery room and bonding with the baby. But they can also be very detailed, including items like how the mom ought to be positioned during birth, what is happening with the placenta and even religious or cultural positions.
But the big question is how much this plan is respected, especially when the hospitals have their own policies which basically reign supreme. We’ve had several doctors point towards Ecuador laws which at their essence basically say we need to preserve human life at all costs.
05:22
I remember studying medical cases in law school, especially around this point. It can get complex quickly. One of the more common examples is Jehovah’s Witnesses refusing blood transfusions because it’s against their religion. Here in Ecuador, doctors are obliged to ignore their wishes and proceed with the blood transfusion if it will preserve human life.
Now, it’s really hard to argue with a law that above all, aims to protect human life, but here I go. Our experience, and those of many mothers we’ve talked to here, is that doctors use these laws not just as a shield but as a sword for their own convenience.
06:05
Hospitals are set up to maximize convenience for the doctors, not health outcomes for the mothers and their babies. For example, we’ve come across hospital birthing setups where the default and often the only option for a natural birth is for it to happen on a quirofano, which is basically an operating room. Doctors opt for this in case surgery needs to be performed and the argument is that they can do it quicker and more efficiently. Now, what’s the issue with this? In short, a lot. At a high level we’re normalizing surgery as the main birthing delivery mechanism. But there are significant health trade-offs we’re making too.
06:45
For example, there are lots of people coming in and out of these rooms. You’ve got the doctors, nurses, interns, students, mothers, family members, etcetera and it is really, really hard to properly disinfect these rooms for each new delivery. So there is a much higher infection risk than a private room that has been properly disinfected.
And then we have all the environmental questions. Do we really want our kids to be born in this cold factory-like hospital or do we want their first breath to be, well, anywhere else?
We’re still trying to come to terms with the exact details of the birth plan for our latest child, but we certainly want it to be in a warm, welcoming environment filled with love.
07:33
But our options are very limited and it really does feel like we are fighting the entire hospital birth industrialisation complex. It’s just a battle we cannot win, certainly not in the next two months before our child is born.
I’ll get to what our current plan is in a minute, but for now I do want to touch on our most recent birth experience around 2 and a half almost three years ago. Our primary plan was to have an in-home birth accompanied by a birth doula, midwife and a surgeon, also at the house in case of an emergency. The day came and it started out wonderfully. Michelle was empowered and we had prepared with all the right touches that we wanted. The music, the lighting, the candles, the cushions and even the tub in case a water birth was possible.
08:23
But when labor approached, the baby just didn’t want to position himself properly. He was basically stuck on one side and refused to stay in the middle where the birth canal is located. We tried to gently maneuver him into the correct birthing position, but that’s the very first indication that we got that our son was going to be very stubborn. He wouldn’t move. He was just also bigger than the two previous babies, so this also made it more difficult to position him properly.
08:53
Hours passed and the dilation continued. Still no change in position. It was time to start rethinking our birth plan. In particular, it was time to hit Plan B. The midwife, surgeon and Michelle all agreed that a natural birth was now very unlikely and it was time to go to hospital.
We were also living in Challuabamba at the time so getting into Cuenca was a little bit difficult. Thankfully it was late at night so there wasn’t much traffic. Michelle was fighting contractions so we did have to pull over several times but we made it to the hospital in around 25 minutes.
09:31
Michelle was also prepped for surgery and and I was taken to a room where I was instructed to change into hospital attire or the scrubs I think they may be called, I’m not really sure exactly. But just as I was about to leave the room, another doctor who I had never met before came in and said that there was a change of plan and I would not be allowed into the delivery or surgery rooms to see my son be born.
09:59
I was beyond furious. The reason they gave was general COVID safety, and this was during the later stages of COVID when hospitals were mostly starting to open up their COVID protocols for certain things. Turns out the night before the hospital had some sort of COVID policy breach and the knee jerk response was to basically just tighten everything to the extreme, including not letting anyone except the mother into these rooms. Now, part of me can certainly accept the policy change, but no part of me can accept the way that this policy change was implemented.
10:40
The surgeon that accompanied us at the house was the same surgeon that worked exclusively for this hospital. But the hospital hadn’t communicated this policy change to the surgeon, even though they had an entire day to do so. If we would have known, we absolutely would have changed hospitals.
So here I was told by a doctor I’d never met before that now, because of a random policy change that was not communicated, I would not be able to see my son be born.
11:11
Now, at this point, this was really the closest that I’ve ever come to a physical altercation in Ecuador.
It got very intense. Everything in my body was telling me that I needed to be there, not just to work on my son into the world, but also to be there for Michelle, just in case. My spidey sense was tingling at this point. Their story didn’t quite feel right, and turns out I did have reason to be concerned. We later found out that the real reason they wouldn’t let me in was to ensure they didn’t have any witnesses.
11:49
A few weeks before our birth they had another delivery which had significant complications, and the parents were in the process of suing the hospital. So the hospital decided to avoid future lawsuits by simply banning witnesses and then use the confusion around COVID to hide what it was doing. I only found this out in hindsight, so it’s impossible to know how I would have reacted if I discovered the truth that night. My reaction to the cover COVID story was hostile enough. I can’t remember the exact words that I used, but I wasn’t shy in letting them know how terrible this experience was.
12:31
I’m not proud that I lost my cool in this way. I do generally pride myself on being able to control my emotions, but I just couldn’t. I was livid and I didn’t care who I had to take on at this point. The whole hospital administration was in my crosshairs and I let it be known. I finally started to calm down when I realized that regardless of how much it hurt, that I couldn’t be in the same room as Michelle and the baby. But fighting at that exact moment wasn’t going to provide a better outcome for Michelle or the baby.
13:03
The only thing I was going to do was make it worse at this point.
So I just sat there alone in a room with my ear at the door, listening for progress. It was clear Michelle wasn’t doing great and I was scared. I was very scared for the life of Michelle and our baby.
20 minutes or so passed in this state and then I heard screams. The unmistakable sounds of a newborn baby.
13:28
That was the scream and nobody told me, but I knew at that point that it was my baby. I knew that scream for some reason.
I saw the nurses walking down the hallway towards my room with him in their arms and they did allow me to have a quick look at him but not hold for a few seconds before they vanished again.
Another 30 minutes or so and I was allowed into the recovery room with Michelle. She was weak and it was clear she had been through a lot.
13:57
Whilst cutting the incision for the C-section the surgeon hit a cyst which caused a lot of bleeding and complicated the delivery. There were several other issues that really could have been avoided and honestly it was a bit of a mess and we were far from impressed with the entire experience.
But our baby was healthy and Michelle would make a full recovery. The relief was just simply indescribable. That whole feeling of life is going to be OK again.
14:27
All at once, everything else faded away and we just enjoyed having little William with us for the first time. William was the name of my late grandfather.
The next day it was time for the siblings to meet more issues. Michelle and the baby were recovering, however, the hospital refused to let our two other kids visit their mother and brother in our private room. I was so far beyond arguing with them at this point. I just snuck them past security and reception so they could be with their family. I do have a feeling that they saw me doing it, but I’m also certain that word has spread that this family isn’t going to back down if they pushed us on some sort of COVID related policy issue.
15:11
As exhausted as I was, I was indeed ready to take it as high as they wanted to go, most likely even higher. As terrible as this experience was, I don’t want you leaving this video thinking that Cuenca has terrible hospitals and healthcare. It doesn’t. We’ve found some great healthcare providers and we’ve also had successful surgeries. William also had a follow up surgery in a different hospital with a different surgeon and around the six month mark. It went off without a hitch and we’re very, very grateful for the team that helped him.
But this one particular issue of healthcare, giving birth, does seem to be an exception.
15:52
Maité, the Belgian doctor that I interviewed, also gave birth in Cuenca, and she’s the first to acknowledge that the current approach to childbirth is very conservative and favors doctor convenience above all else. I think it’s a genuine problem that needs to be addressed.
So what does our current birth plan look like? Very good question. We’re still figuring out some of the finer details.
The biggest outstanding decision is whether we’ll opt for a natural hospital birth, complete with our own room, or have a natural birth in our house. The previous C-section complicates this and it just may be the deciding factor that nudges us towards a hospital birth. There is a heightened risk of complications given the prior C-section.
We’re considering various hospitals for this.
16:44
The two that are top of the list are Clinica Latino. They have some very good facilities and offer a private room with some customisations for the birth, such as our own music.
They understandably denied our request for a candle as this wouldn’t play nice with the oxygen supply. The average cost for a natural birth there is around nineteen hundred and a C-section is around two thousand seven hundred. These are prices without complications. The other option we are considering is the hospital closest to us and that is Hospital Del Rio. The cost here is a little bit cheaper, around fourteen hundred dollars for a natural birth and 2000 for a C-section.
17:26
Note that these are two of the most expensive private hospitals in Cuenca. I’m very sure that you can find cheaper alternatives. We just happen to be very fortunate that we are in a financial position where 2 or $3000 is fine for this sort of thing, so cost is not a real consideration in our choice.
Now a quick word on health insurance. If you are considering having a baby in Ecuador and want to be covered, you’ll absolutely need to ensure your policy covers pregnancy and giving birth.
17:58
And of course you’ll need to have insurance before you are pregnant or it will be considered a pre-existing condition. And of course, you’re not going to be covered.
We still have a few weeks to finalize our birth plan. It’s unlikely to be the perfect birth that we may have dreamed about and we’ve come to terms with that.
I very clearly do not have all the answers when it comes to giving birth in Cuenca. I said at the start of this video that there is not going to be a neat ending.
I don’t even have any real suggestions for you on figuring out your own path forward. It’s a tough one. It really is a difficult topic.
18:39
Life in Cuenca or anywhere is not perfect. Like us, you may find that you need to take more charge over certain aspects of your healthcare or other important aspects of your life.
The flip side of this is freedom. You do have more freedom to make the choices that directly affect you.
This includes things like renting. Maybe check out this video of my own Cuenca rental experience next.
Ciao ciao
