Birth in Northeast Brazil: Part 3

Birthing in Brazil Series

Part 3: Obstetric violence in NE Brazil

Everywhere you turn here in  the rural Northeast of Brazil you face obstetric violence in one form or another. You usually have three options when it comes to labor and birth, and their are serious problems with all three.  Here are your main options as a mother in Brazil:

1) Birth in a public hospital. Here is what you have to look forward to: Rundown facilities with a lack of supplies. You may have to share your room, and your labor space. There may be no bed for you. No bed for the baby. No basic care items for the baby. The doctor may not be in town and you may have to rush to another hospital in another town. Your companion may be forced to wait elsewhere. If a doctor is around he (or she) will most likely use verbal abuse to keep you quiet and complacent. If you get a bed, you may be forced to lay down on the bed for the whole labor and even be strapped or tied down. Episiotomies are common. So is the Kristeller maneuver. So is the doctor sitting on your belly forcing the baby down. If you need an emergency c-section it may be not started quickly enough to save the baby and the mother.  There is a great likelihood that you will not receive a lifesaving procedure such as pitocin after birth or a blood transfusion for hemorrhaging (a common complication after the Kristeller maneuver, episiotomies, and c-sections).  You will not get the attention needed for a pregnant woman in labor and your likelihood of morbidity and mortality is high.  

2) Birth in a private hospital, with a private doctor. Here is what you have to look forward to: A beautiful well equipped pristine setting with a 75-100% c-section rate.  When you meet with your doctor before birth she will do her best to convince you that a c-section is best. If you don’t agree she will coerce you, rationalize with you, and even lie to you to get you to do a c-section, or just refuse to deliver your baby. At best, if you try to birth normally in a private hospital without a supportive doctor you will be ridiculed by the staff, ignored, stared at, called crazy by the other mothers and medical professionals, and in the end you will most likely have a c-section.  At worst, you will experience the Kristeller maneuver, an episiotomy, unnecessary pitocin, overdoses of pain medication, and an epidural (whether you want it/need it or not). Or you can just give in and schedule your c-section, where there is a high likelihood that your baby will be born premature and you will have other complications due to an unnecessary major abdominal surgery. Regardless of if you have a c-section or normal birth, your baby will be taken away to the nursery, “made presentable,”  and given formula making nursing difficult, if not impossible.

3) Often misunderstood or unheard of, humanized birth. I’ll explain this more in another part of our series.

A little more about obstetric violence (or obstetric abuse): “Obstetric violence takes two forms: physical, manifested in invasive practices, unnecessary use of medicines and disregard for the time required or eventualities of labor; and psychological, meaning dehumanizing or rude treatment and discrimination or humiliation when a woman seeks advice or medical attention”  (Obstetric Violence - gire.org).

The types of obstetric violence that occur in NE brazil include:

During pregnancy:

• Denying prenatal services to a woman or imposes difficulties in treatment
• Health officials neglecting to provide high quality treatment for a pregnant woman;
• A cesarean section is scheduled without recommendation based on scientific evidence. This can include social coercion and intimidation by the medical professional (ex. no one has babies vaginally anymore, it’s barbaric, it will ruin your sex life, you can’t handle the pain), medical coercion from a medical professional (you are too small, you are too big, your baby is too big, your baby is too small, ), and even complete lies (doctors lie about babies being breach, the umbilical cord is too short, the umbilical cord is too long, the cord is wrapped around the baby’s neck and the baby will suffocate [nuchal cord], the baby is overdue [at 40 wks], the baby does not have enough amniotic fluid, the baby has too much amniotic fluid, hemorrhoids, the baby doesn’t want to come, a part of the baby’s body is stuck in the mother’s ribs [seriously..]).

During labor:

• The hospital will turn away a woman in labor.
• There is a lack of or withheld essential life-saving and important care equipment.
• A woman in labor is left alone and not allowed her partner or other companion.
• Procedures on the woman’s body that interfere in the process of childbirth, cause pain or physical injury (be that to be slight or grave). Examples: administering serum with oxytocin in order to accelerate the childbirth (for to the doctor’s convenience, with no medical necessity), successive manual examinations by different people on the woman’s cervix (introducing higher likelihood of infection); no food provided for the woman in labour; episiotomy (surgical incision used to enlarge the vaginal opening); immobilization (arms and legs), etc.;  the Kristeller maneuver (applying pressure to get the baby to move down the birth canal), sitting on the mother’s belling and attempting to push the baby down the birth canal
• Verbal abuse during labor (shouting at the woman to keep quiet, telling her that if she yells too loud she’ll harm her baby, saying overly sexualized comments such as “you didn’t complain when you were making the baby, so stop complaining now”)
• Performance of cesarean surgery without clinical indication or the woman’s consent
• Denying or delaying a cesarean surgery when medically necessary

Directly after birth:

• Delay or prevention of the woman’s contact with the baby just after the birth
• 
  

  Preventing or hampering of breastfeeding (preventing it during the first hour after the child’s birth, separating the baby from the mother, leaving the baby in the nursery where baby bottles and pacifiers are used, etc.)
• Denying or not providing life-saving procedures when necessary (such as blood transfusions, intravenous liquids, pitocin to shrink the uterus back down when needed, suturing as needed)
• Overuse of medical interventions (prolonged intravenous liquids, over-dosage of pitocin, overdose or incorrect dosage of pain and other medications)

 Sometimes the abuse is “minor” but often it is extreme and leads to poor maternal and infant outcomes after birth.

In part 4 of the series, I will talk about humanized birth and what a difference it can make!


-Lindsay

"Obstetric Violence: do you know what it is? - Defensoria." 2014. 26 Aug. 2015 <http://www.defensoria.sp.gov.br/dpesp/repositorio/41/VIOLENCIA.OBSTETRICA_ingles.pdf>

"Obstetric violence | May 28." 2015. 26 Aug. 2015 <http://www.may28.org/obstetric-violence/>