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Brazilian women on vaginal labor and cesarean section
– Reported, January 26, 2013
Latin America is one of the regions with the highest rates of cesarean sections in the world,with a tendency towards further increase. Recent estimates indicate that the incidence of cesarean sections varies between 16.8 and 40% in most Latin American countries; and that this rate is higher in private hospitals than in state-run hospitals; also that it is greater in countries with higher per capita gross domestic product. In Brazil, the proportion of cesarean sections paid by the Public Health System SUS in 1997 was 31.97% . The Live Births Information System SINASC calculates that in 1998, 38.1% of births were carried out via cesarean section . The World Health Organization WHO indicates a maximum of 15% cesarean deliveries to be desirable, it is clear that the number of unnecessary cesarean sections performed annually in Brazil is very high.
The incidence of cesarean sections is also greater among women with more years of education and among those who delivered in private hospitals . The high proportion of cesarean sections cannot be explained by an excess of high risk deliveries in public hospitals, as over 90% of all births occur in hospital. In addition, the highest cesarean sections rates occur in hospitals caring for women who have private health insurance and better socioeconomic standards, among whom the incidence of conditions associated with high obstetric risk is the lowest.This high prevalence and the higher risks for both mother and child with cesarean sections, has led to the search for reasons that could explain why this type of delivery has become the most popular in Brazil.
On one hand, doctors tend to prefer cesarean sections, considering them more convenient since they fear accusations of technical inability, if confronted with a complicated vaginal delivery, added to the shorter time required to carry out a cesarean section as compared with a vaginal delivery. On the other hand, according to these authors, women also show a strong preference for this kind of delivery, associated with the fear of vaginal labor, speci?cally the pain, as well as their belief that this form of labor is riskier for the baby and that it may have a negative effect on their sexual life.
It is important to note that all but two of the women in the group who had vaginal deliveries had also had cesarean section, meaning that they could compare both experiences. This may have contributed to their more favorable opinion of vaginal delivery. The positive evaluation of vaginal delivery reached to the point that almost half of those with previous experience did not refer any disadvantage of this mode of delivery, and almost one-third of them did not note any advantage of having a surgical delivery.
It would be easy to conclude that the responsibility for the high cesarean section rate falls over the other participants in this process, i.e. the doctors. To attribute to these professionals the entire responsibility for the excessive number of cesarean sections would be simplistic, as it would ignore the interactive aspects of the relationship between doctors and women, as well as the wider social context of the current health system where both are placed. Requesting and considering womens opinions on the best way they would like to give birth is an integral part of the process to recover the womans role of protagonist in childbirth. This is a recent trend in Brazil, which above all, should be part of the recovery of mutual respect between health professionals and women in everything that is related to childbirth. A deeper exploration of the perception of these processes and of the complexity of the relationships between all the participants involved is required.
CREDITS:
http://www.pbh.gov.br/
M.J.D. Osis, K.S. Padua, G.A. Duarte, T.R. Souza, A. Faundes
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