This is the third post in a blog series called “Expectations" written by deputy editor of global health Marissa Miley. Expecting a child herself, Miley is reporting in Brazil to better understand how women experience pregnancy and childbirth. Read Part I and Part II.
RECIFE, Brazil—My doctor has not yet broached the topic of my baby’s delivery. She has not mentioned anything about anesthesia or drugs, about doulas or birthing coaches – not about how I’m supposed to train to breathe now that it seems Lamaze classes have fallen out of fashion. I’m not concerned. As I get closer to my due date, I know we — my doctor, my husband, and I — will talk about all of these things and that I’ll be informed and empowered to make the right decisions for me.
One choice I won’t make, though, will be whether to have a Cesarean section. In the United States, this procedure — where the baby is surgically removed from the womb — is generally reserved for medical complications or high-risk pregnancies. C-sections, after all, carry greater risks of infection and complications, and their rapid increase in recent decades has mobilized concerned US doctors to curb the trend with new guidelines. Still, the overwhelming majority of American babies — two-thirds — are delivered by vaginal delivery each year.
In Brazil, however, C-sections are far more common than vaginal births. On the surface, this appears to be because women prefer them. In private hospitals, where an estimated one-quarter of Brazilians receive their care and can afford to pay a premium, more than 80 percent of babies are born by C-section. In the more widely used public health system, this proportion is lower —around half of all births— but that’s still a higher percentage than in the US. And it’s dramatically higher than the World Health Organization’s recommendation that no more than 15 percent of babies be delivered by C-section.
But dig a little deeper behind the numbers in Brazil and it becomes clear that C-sections are not always something women choose. Nor are C-sections always performed because they’re medically needed, according to many women and doctors I’ve spoken with here. In fact, many believe that there is a pervasive culture of disrespect in the Brazilian health care system for women’s autonomy around this issue.