| Rosa Sulleiro |
SAO PAULO (AFP) – Brazil says it must stem the “epidemic” of Caesarean sections — now more than half of all births, or more than any other country in the world.
Whether from a fear of pain or that a vaginal birth will leave permanent changes in their sex life – or based on the recommendation of doctors perhaps looking to bag higher fees associated with the surgery — more and more Brazilian women are foregoing labor altogether in favor of scheduled C-sections.
Data show the procedure is used to deliver an average of 56 per cent of babies in the nation of 202 million, with the figure soaring to nearly 85 per cent in private clinics.
That’s well above the World Health Organization (WHO) recommendation of 15 per cent.
“The epidemic of Caesarean births in the country is unacceptable and it must be treated as a public health problem,” said Health Minister Arthur Chioro.
The health ministry warns that the procedure increases the risk of respiratory difficulties for the baby by 120 per cent and also triples the risk of the mother dying.
Aiming to reverse the tide, the government this week launched an initiative tightening controls on doctors and seeking to dissuade mothers-to-be from having a C-section unless deemed medically necessary.
From July, Brazilian women who take out private insurance will be able to request that their doctor and health center provide statistics on how many Caesarean deliveries are carried out there.
Private doctors will be legally obliged to inform mothers of the risks that go with electing to have a Caesarean.
“Furthermore, in order to receive his fees, a doctor will have to fill in a form with all the data on the woman from the time she starts having contractions,” Andre Longo, chairman of Brazil’s national complementary health agency (ANS), told AFP. That would require doctors to wait for contractions to begin before undertaking a Caesarean.
Asked at the early stages of their pregnancies, around seven in 10 Brazilian women say they would prefer a natural birth.
But by the time they reach full term, a far lower number end up with vaginal deliveries.
Many Brazilian women opt for C-sections to avoid the pain of natural labour, but also in the belief a vaginal delivery will negatively impact her sex life, said Vera Fonseca, director of the Brazilian Federation of Gynecological Associations.
“The Brazilian woman is concerned with her sexuality and fears that giving birth will alter the perineum, which is a myth,” she told the Folha de Sao Paulo newspaper.
Another factor is the poor reputation of the public health system.
“Public sector accompaniment of births in Brazil is a very violent and crude practice, and women do not want to go through that. So they fall back on their (private) health plan where profit is the objective,” says Ana Cristina Duarte, coordinator with maternity support group GAMA.
Duarte believes the government has failed to get to a grip on the problem by, for example, fining service providers guilty of poor practice.
“They just restrict themselves to demanding better assistance without forbidding anything,” Duarte told AFP.
“In Brazil, people think of a Caesarean as a way of giving birth rather than as a form of surgery. They are not alert to the risks,” she added.
The prestigious Albert Einstein clinic in Sao Paulo recently launched a programme to encourage mothers to have a natural birth, but still some three-quarters of births there are C-sections.
“Many women fear a natural birth, and doctors generally see it as convenient to fix a day ahead of time” with a scheduled Caesarian, the clinic’s maternity coordinator Rita Sanchez told AFP.
ANS, the private sector regulator, covering some 25 per cent of Brazilian citizens, recognises government initiatives will have limits.
“We are strongly regulating what the law allows us to do,” said Longo.
However, “we don’t have the power to act directly on doctors and hospitals,” he stressed, adding that the measures discussed to date “are not a panacea”.