According to the Ministry of Health, System of Information on Live Births, Brazil has one of the highest c-section rates in the world (between 30-40%, when the normal rate, according to the World Health Organization, should be 15%).
The worst thing about this percentage is that c-sections in private hospitals reach 90%!!! while attaining a mere 30-40% in public hospitals.
So the question is, why do class ABC Brazilians prefer c-section?
In my experience, it´s the doctor that basically forces this option on the mother-to-be. A friend who recently had a child told me he had to negotiate natural birth with his doctor, and was refused (?). On the actual day, his wife arrived at the hospital with 2 cms. dilation, which was considered “bad” by the doctor, and she was subsequently rushed to have her unscheduled c-section.
In Argentina, at least, 2 cms. is considered normal. Nurses wait around for the numbers to increase, check pulse and give you medication to relax, and the baby is only born when it´s ready. This is not the case in Brazil. Some of the reasons for this shocking reality are:
a) It´s more comfortable for the doctor to schedule a birth instead of getting a midnight call and rushing to hospital to delivery a baby naturally.
b) Private practice is not very controlled in Brazil. Inexperienced doctors get hired in lush clinics, and have no idea how to handle obstetric emergencies. C-section is safe and easy, for them.
According to some pro-natural birth obstetricians, there is also the legal issue. C-section results in less medical mistakes and accidents, which is better for the clinic.
I happened to have my second daughter in a public hospital in Bahia. Before raising a “so-what” eyebrow, consider that public hospitals are reserved for the poor only. Almost every other social class can afford a private health plan, dreading the idea of even setting foot in a public hospital. This is a cultural thing. Public hospitals equals poverty.
The doctor arrived 5 minutes before she was born, before which I was waited on by a very kind and tired nurse. I was inspected every 2 hours for dilation. The doctor who delivered my daughter, so I found out, was a semi-eminence in the medical world, and greatly loved and respected by the mothers who had had babies their before. He was almost elderly (the best type of doctor in my opinion), no-nonsence, obvisouly experienced and extremely skillful. This is a rarity in private hospitals, so I was already feeling very pleased with myself.
At one point, a woman walked in asking if anyone wanted a c-section, as if she were offering water. We all shook our heads and continued panting waiting for our turn in the queue.
Another factor generally stated by obstetricians for the unfounded preference for c-sections is “pressure” (from family or friends), but I disagree. Most of the women I have talked to about this feel no pressure. They simply want natural birth and their doctor does not. I once suspected it was a vanity issue, and that some women think they will be less attractive sexually after natural birth, but husbands are usually the first to hoist the flag of natural birth only to be confronted with a broad, “no” and subsequent win-lose negotiation tactics.
The Ministry of Health has tried to raise awareness on this issue, but they have pointed their efforts in the wrong direction. Their entire short-lived campaign was targeted at the mothers, not at the doctors, hence the failure of sparking the expected response. They simply interviewed some public health doctors, who list the benefits of natural birth with total disinterest (because it is not a public health problem) without discussing or knowing the real reasons some women agree to c-section.
In my view, this issue is far from being solved. Doctors are younger, more fearful and getting pressure from private clinics to schedule c-sections. Brazilian couples, on the other hand, are too misinformed or afraid to complain and stand up to how they want their children to be born. This aspect of Brazilian society is definately a cultural issue: the paralizing reluctance to complain and demand ones rights.