Tuesday, August 04, 2015

Birthing in (Northeast) Brazil: Part 2, Julia's Story

Birthing in Brazil Series
Part 2: Julia’s Story

I want to tell a little story today. When people read the statistics about the increasing c-section rate in Brazil, they usually ask me, why? Is it really that women are scared of childbirth?  Is it that doctors really don’t do normal birth?  It just doesn’t make sense to people from our culture why someone would choose major abdominal surgery over a “natural process.”

Well, to help you understand a bit better let me tell you the story of Julia.*
36 years ago, Julia’s mother gave birth to Julia via a planned c-section. Julia’s mother lived in the rural interior of Brazil. Her town had a public hospital, but it was not guaranteed there would be a doctor or medical supplies necessary. Julia’s father was a fairly successful local business owner and loved his wife dearly. He knew many women died in labor and even lost his mother after the birth of his sister. Instead of relying on the local (often uneducated) midwives he decided to take his wife to an obstetrician. The obstetrician was from out of town and could not guarantee he would be around when the time came for her to give birth. He was young and recently had been trained to do birth by c-section. He personally saw lives saved from the procedure, especially when compared to unattended births or births by untrained midwives. He recommended scheduling a cesarean birth for when he would be in town  to guarantee the safety of the mother and the baby.  

Julia was born healthy and happy. Three years later her brother joined her in the world in the same manner.
Julia’s mother accredited her children’s survival, and her own, to childbirth by c-section. She saw many of her friends and relatives die in childbirth or shortly after. During the late 60’s to early 80’s the infant mortality rate within the first year was 200-300 infant deaths per 100,000 live births. ("BRAZIL: No More Angel Babies on the Alto | Center for Latin ..." 2013. 4 Aug. 2015 <http://clas.berkeley.edu/research/brazil-no-more-angel-babies-alto>) While many of those deaths were due to malnutrition and illness within the first year, folk superstitions often blamed the violence of childbirth.  For Julia’s mother the c-section was a miracle! She tells her friends and family and those who can afford it start to have planned c-sections also.

36 years later, Julia is even more well off than her mother and father. With time Julia marries and gets pregnant. All of her friends and family have had scheduled c-sections. Her mother had a c-section. Her doctor recommends a scheduled c-section. Normal childbirth doesn’t even seem like an option. She doesn't know anyone in her social circle that has done it. It seems primitive and risky. Even though she lives close to a “good public hospital,” she has heard horror stories of violence in labor and maternal and infant deaths at that hospital.  Even if she mentions normal birth, her doctor laughs it off and tells her that she won’t be able to handle the pain of childbirth, he says you are too petite for normal labor and your baby is already very large. She wants the best for her baby so at her first prenatal appointment she schedules the date of her baby's birth.

Does Julia really have any other good options?  Why would she even consider vaginal birth as a healthy option?

*Julia is a character made up from three stories of three different friends here in Brazil, but her story (and her mother’s) is very common and is very similar to the story of most of the women who schedule a c-section in their first doctor’s appointment.

I hope this story helps outsiders to see a little more about why women here in the interior would choose c-sections. Next week I'll get into more about obstetric violence in the public (and private) sector!


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