As of this week, it will be much harder for expectant mothers in Brazil to undergo Cesarean births out of convenience rather than medical necessity. New laws aim to curb the overwhelming popularity of the procedure and educate families about other delivery options.
Under the new regulations, which Brazilian officials rolled out as part of a national campaign dubbed “Childbirth is Normal!”, doctors and hospitals have to share information with patients about the number of Cesarean births carried out in their facilities. Parties that fail to divulge such information may face fines of up to $8,000.
“Childbirth is one of the most important moments in the life of a woman and her family,” Jose Carlos de Souza Abrahao, director of ANS, a specialized health ministry agency in Brazil, told AFP News. “By informing her of the risks that could come with an unnecessary surgical procedure, she will be more sure in her decision regarding the delivery, choosing what’s best for her health and for her baby’s health.”
The “Childbirth is Normal!” movement comes on the heels of other Brazilian government programming aimed at promoting natural childbirth. The Stork Network, for example, educates mothers and doctors about the benefits of vaginal delivery. Long before the sea of change, women activist groups have sought some autonomy for expectant mothers they say are bullied by doctors. Earlier this year, protesters took to the streets in the city of Recife and flooded social media, highlighting the policy issue with the #SomosTodosAdelir hashtag.
During Cesarean birth — a procedure commonly known as a “C-section” — doctors deliver a baby through a small incision in the mother’s abdomen. It has proven to be life-saving for women who have difficult deliveries. However, the operation currently accounts for more than half of births in Brazil, a nation of 200 million. It’s popular among more than four out of five mothers with private insurance who want to choose their delivery date. In public facilities, 40 percent of newborns have C-section births. Both figures eclipse the World Health Organization’s recommendation of 10 to 15 percent.
Even with the high risk of infection, heavy blood loss, blood clots in legs and lungs, and nausea, associated with cesarean births, many Brazilian women — as many as seven out of 10 — agree to the procedure. Experts point to negative perceptions about natural birth and the structure of the Brazilian private health care system as key culprits.
For mothers who can afford private health care, C-sections can be easily scheduled and carried out quickly. With strategic scheduling, doctors can complete up to eight cesarean births per day, compared to two natural births, making the former the more lucrative option for hospitals. This reality often compels doctors to coerce their female patients into going under the knife, even when they wouldn’t have chosen to do so. One mother who acquiesced to her doctor’s demands sought psychiatric help shortly after the birth. Another woman succumbed to police threats earlier this year to deliver via Cesarean birth.
If doctors don’t provide enough of an impetus, the dearth of alternatives ultimately compel expectant mothers to undergo a C-section. Brazil has outlawed abortion, except if the pregnancy happened as a result of rape. Additionally, those who initially plan to have a natural birth often hear that no beds are available for them in lieu of deliveries scheduled to take place. That’s why avoiding C -section birth in Brazil often requires one to aimlessly hop between public hospitals in search of an empty bed or pay a bribe to doctors.
However, those who successfully lobby to give birth naturally will more than likely undergo a violent process — which often includes a cutting of the vaginal opening — in tandem with the hospital staff’s verbal and physical abuse. Mothers have also recounted instances when doctors pushed on their stomachs to speed the delivery along. It’s for this reason that Cesarean birth — often seen as a cleaner and more regal option — has become a status symbol in Brazilian society.
“Here, when a woman is going to give birth, even natural birth, the first thing many hospitals do is tie her to the bed by putting an IV in her arm, so she can’t walk, can’t take a bath, can’t hug her husband. The use of drugs to accelerate contractions is very common, as are episiotomies,” Maria do Carmo Leal, a researcher at the National Public Health School at the Oswaldo Cruz Foundation, told the Associated Press. “What you get is a lot of pain, and a horror of childbirth. This makes a cesarean a dream for many women.”
The same holds true for expectant mothers in the United States and China, where rates of C-section births hover around 50 percent and 30 percent respectively. While Chinese mothers want their child’s birth date to fall on a “lucky number”, American doctors see the birth as a technique in avoiding lawsuits that can damage their reputation and that of their doctors. Efforts have gone underway domestically to increase natural births, with one hospital making progress by sharing each physician’s rate with others in the obstetrics department.