Published On: July 31, 2015

New Regulations to Reduce Caesarian Births

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New regulations aimed at decreasing Brazil’s obsession with Caesarian births took effect this month, with the government hoping it can alter the country’s image as a leader in this operation. Some hospitals in Brazil have the highest rates of Caesarian births in the world.

The new regulations are part of a campaign called “Childbirth is normal!” The campaign is headed by the government’s Health Minister, Arthur Chioro. Brazil has an “epidemic” of Caesarian births, abbreviated as C-sections, which currently account for more than 50 percent of all births in Brazil.

In the US, the current percentage of C-section births is about 33 percent. C-section rates have increased in the US from just over 20 percent in 1996 to 33 percent in 2011. However, the World Health Organization recommends a far smaller number – 10 to 15 percent.

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An interesting element of the unusually high rates in Brazil is the discrepancy between public hospitals, where the majority of patients are of lower income and utilize Brazil’s universal healthcare coverage, and women giving birth in hospitals using private health insurance. About 84 percent of Brazilian mothers with private health care plans undergo C-sections, while the figure is about 40 percent in public hospitals.

Doctors in private hospitals in Brazil, when queried regarding the 84 percent statistic, say they are only following the requests of their patients. As C-sections are so common in Brazil, oftentimes expectant mothers are relying on the advice of family and friends who have also had C-sections. Exactly how the habit of requesting C-sections started in Brazil is unclear. Researchers say many Brazilian women see Caesarians as more civilized and modern, and natural birth as primitive and ugly.pregnant_2

One factor in the rise of C-section births is the convenience of being able to choose the date. This makes for easier scheduling for both families and doctors. Also, families target a specific date for numerology reasons, such as the birth date coinciding with the birthday of an important family member.

Another factor that may play a role in the popularity of C-sections in Brazil is vanity. With the operation being so commonplace, the technology has developed to a level of sophistication where only a small scar is left on the mother’s abdomen, an incision scar below the bikini line. Some women, particularly those who choose smaller bikinis, will then have cosmetic surgery to remove the C-section scar. A third factor is there are women who believe that vaginal births can have a negative effect on their sex lives, making them sexually less attractive.

One Brazilian mother who has had two children said that with her first child, delivered vaginally, the pain was so great that she was given strong drugs and became very drowsy. However, for her second child, she chose a C-section delivery with local anesthesia. As a result, she was awake and alert during the delivery. She says the C-section birth was more memorable because she was focused on the experience, while with her vaginal birth, she was waiting for it to be over. She also noted that when she informed her doctor of her desire to have a C-section for her second child, she expected the doctor to protest, but he readily agreed.

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Under the new government rules, doctors and hospitals in Brazil are now required to share information with patients, such as the dangers involved with C-sections. Doctors must ask their patients to sign a consent form before performing a C-section. If doctors fail to have the consent forms, the private health insurance companies face fines of up to about U$8,000. Also, to have the private health insurance companies cover the cost of the hospital stay, doctors will have to justify why a C-section was necessary. They must fill out a record of how the labor and birth developed and explain their actions.

Each pregnant woman will now be assigned medical notes which record the history of her pregnancy that she can take with her if she changes doctors. The new rules are designed to reduce unnecessary surgical procedures and ensure pregnant women are aware of the risks associated with Caesarians.

Making patients better informed will help diminish the demand for C-sections, health officials say. “By informing the expecting mother of the risks that could come with an unnecessary surgical procedure like a C-section, she will be more sure in her decision regarding the delivery, choosing what’s best for her health and for her baby’s health,” said José Carlos de Souza Abrahão, director of a specialized health ministry agency.

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However, experts say that a scarcity of maternity beds and wards equipped to deal with natural births means that for some women in Brazil, a C-section birth is seen as the best option. “The best way to guarantee yourself a bed in a good hospital is to book a C-section,” Pedro Octavio de Britto Pereira, an obstetrician and professor at the Federal University of Rio de Janeiro, said in an interview with BBC Brasil. Women who want to give birth naturally in a private hospital have reported finding all the beds are reserved for scheduled C-section deliveries. There have been reports of women going into labor without a C-section scheduled and being forced to travel from hospital to hospital in search of a bed.

Gynecologist Renato Sa said: “Doctors are responsible for what happens and in a situation of risk they may chose a C-section because if there is a complication they will be asked why they didn’t do this. Doctors are afraid of natural childbirth. With a C-section, they feel more protected from litigation.”

 

 

[Research for this article comes from the BBC and the AFP news agency.]

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