Brazil, the land of talking exotic birds, is wrestling with a childbirth culture that has, in recent years, relied on interventionist procedures such as C-sections. More than half of all babies born in Brazil are delivered via cesarean, a figure, according to the Associated Press, that rises to 82 percent for women on private insurance.
Last month, however, Brazilian women, in a push to gain more control over childbirth, organized 13 marches all over the country, largely in response to a medical regulating agency in Rio de Janeiro forbidding doctors from performing home births and labor coaches known as "doulas" from helping in hospital wards. During protests in Sao Paulo, women bared their breasts and carried posters that read "Our Children, Our Decision," which all helped secure a court order for the regulating agency's initial resolution to be reversed on July 30.
The World Health Organization cautions against unnecessary and invasive surgeries such as cesareans (which can often lead to complications like clotting and result in longer recovery times), recommending that, though there's no way to determine an "ideal rate," that C-sections should stay somewhere in the 10 to 15 percent range among a general population. In countries like China, however, the rate of C-sections reached 46 percent in 2008, whereas in the U.S. nearly a third of all babies are born via cesarean. In Brazil, experts had long held that vaginal births made childbirth more stressful and dangerous than necessary — cesareans were viewed as the safe, painless and modern way to have children.
However, according to Maria do Carmo Leal, a researcher at the National Public Health School at the Oswaldo Cruz Foundation, such an attitude towards childbirth leads physicians to view the birth as a medical problem rather than a natural process. She says that, oftentimes, hospitals don't offer women much of a choice between natural birth and a cesarean, settling immediately on the latter in order to expedite the birth:
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. What you get is a lot of pain, and a horror of childbirth. This makes a cesarean a dream for many women.
This, in turn, has opened up an entire industry of private clinics that cater to women hoping for natural births. These clinics offer five-star, luxury accommodations, including spa treatments, manicures, and themed rooms for childbirth.
Another big reason, according to Moraes Filho of the Brazilian Gynecologists and Obstetrics Association, that cesareans became so popular is that natural childbirth can last an entire day, whereas a cesarean takes from 30-40 minutes. For doctors who aren't always handsomely compensated for their time and whose time and resources are already spread pretty thin, natural childbirth may simply not be an economically viable option. Explains Filho,
It's not that doctors are mercenaries, but what they earn to be present for a very important moment is little more than what a television repairman gets who shows up on his schedule. This doctor-patient connection where the woman wants her doctor present, the poor remuneration for doctors, their need to juggle several jobs - all this makes it impossible for a practitioner to reconcile his work schedule with unpredictable vaginal births.
Brazil's federal government is, for its part, trying to reverse the C-section trend, with a $1.3 billion healthcare investment over the last year and half, along with another $3.36 billion for a program called "The Stork Network," which is aimed at humanizing birth and educating women (and healthcare practitioners) about the benefits of natural childbirth. The hope is simply to give women more control over childbirth so that the process isn't reduced to a strictly surgical procedure that may not really be necessary after all.