A new government initiative called "Childbirth is Normal!" addresses the epidemic of caesarean births plaguing the country.
A couple months ago, I received a message from a Brazilian friend who was nearing the end of pregnancy. She’d seen my Facebook announcement about having a 9 lb. 6 oz. son at home, just a few weeks earlier, and wanted to know how it was possible.
An overweight 34-week fetus? I’d never heard of that before, and was horrified at the stress that my poor friend was experiencing – all because she wanted to do things differently and have a parto normal, a ‘normal delivery,’ which, in Brazil, simply means a vaginal delivery.
“Here in Brazil the doctors say that the biggest a baby can be for vaginal delivery is 3.5 kilos (just over 7.5 lbs). Any bigger than this, it’s too dangerous and has to be delivered by C-section. I still have six weeks to go and my baby already weighs 2 kilos (4.4 lbs). My doctor says it’s a lot, says it’s actually overweight.”
Mass caesareans are Brazil’s “international shame,” as pediatrician Luciana Herrero called it. The country is notorious for having the world’s highest C-section rate – a shocking 87 percent average of deliveries among women with private health insurance and 50 percent in the government-funded hospitals. Some hospitals report a 99 percent C-section rate. This is a far cry from the World Health Organization’s recommended level of 10 to 15 percent. (The United States hovers around 30 to 35 percent.)
The good news, however, is that Brazil’s government is now on a mission to bring down those numbers. The new pro-natural birth initiative requires doctors to provide information to patients about the many risks involved with having an elective C-section and to get a signed consent form before performing the operation.
Medical Daily reports: “The new ruling also states that doctors must justify the reasoning behind their C-section before proceeding with the operation, and must fill in a complete record of how the labour and birth developed step by step.”
In addition, “Each woman will now be assigned medical notes which record the history of her pregnancy, which she can take with her if she changes doctors,” says the BBC. Doctors will also have to reveal the number of C-sections they and the hospital in which they work have carried out.
It is surprising to learn that these basic things – disclosure of information, patient consent, and a transferable paper trail – are not already part of Brazil’s usually excellent medical care, but implementation is better late than never.
Social change will take much longer, though, as the perceived normality of C-sections is deeply ingrained in Brazil. To have a C-section is seen as more advanced than delving into “uncivilized and primitive” childbirth. It is often mistakenly viewed as being safer, easier, and less painful. It is also a way to guarantee a maternity bed on a specific date.
It reminds me of a conversation I had with another pregnant friend this past winter, when I was visiting Brazil. She was counting down the days till her C-section. “Have you ever considered not doing one?” I asked. She laughed and shook her head. “Oh, no, I wouldn’t even consider it. I’m a C-section girl, through and through.”
Like I said, changing the mentality will take longer, but at least change is on the horizon.