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Giving birth naturally is becoming more difficult as doctors and women opt for cesarean sections.
As head of obstetrics during the 1980s at the Concepcion Palacios, Caracas’ largest maternity hospital, Kizer remembers a cesarean delivery rate of about 10 percent of all births.
Public opinion, at least in Venezuela, holds that cesareans are safer and a fear of giving birth vaginally persists. But a 2005 World Health Organization report carried out in 14 countries in Africa and Latin America found the opposite was true. A higher cesarean rate was associated with an increase in infant mortality, the report said.
“These findings demonstrate that high rates of caesarean delivery do not necessarily indicate better perinatal care, and — conversely — may represent harmful practices leading to poor maternal and newborn health outcomes,” the report concluded.
But even some doctors who advocate natural birth warn about too strong a backlash against cesareans. “In reality the cesarean has saved many lives — it’s not evil,” said Dr. Rodolfo Gomez, executive director of the International MotherBaby Childbirth Organization. “But the cesarean should be reserved for those cases in which the life of the mother or the life of the baby is in danger.”
The WHO has set a cap on what it believes the healthy worldwide cesarean rate should be, establishing lower and upper limits of 5 and 15 percent.
Yet a trend toward more cesareans is difficult to reverse. But it’s a culture that some women are determined to combat. Xiomara Barreto, a social worker from Macuto, a seaside town near Caracas’ airport, persuaded the local mayor’s office to fund a center for natural birth above a state-run clinic.
The center boasts nine bedrooms, a birthing room equipped with a large bath for water births, birthing balls and twelve “facilitators” who counsel women through labor much like midwives.
Yet despite the facility's inauguration in December last year, only two women have given birth there so far because of a dispute over pay between the medical staff and the local mayor’s office.
Barreto said they were able to give the local women antenatal classes and that some were threatening to give birth on the street if the mayor did not hire staff to man the clinic. “The mayor said the doctors would not come because they preferred the pay at private clinics,” she said. “Of course they are going to go somewhere else if you don’t pay them a decent salary.”
Part of the center’s aim is to “humanize” labor, she said. Women in state hospitals are often mistreated, their demands ignored because of staff shortages and a lack of education.
In spite of staffing problems, the center had managed to give women the confidence to demand their rights when they went to give birth at the local hospitals.
“When women from here go to the hospital the doctors know,” she said. "They have realized that our pregnant women have a different attitude.”