Marco Werman: My dad once worked as an obstetrician and what he used to say is that C-sections are designed as an emergency procedure to get a baby out of a woman's womb when complications arise during vaginal childbirth. It's not supposed to be how birth happens. But in some parts of the world, it's practically becoming the norm. In Brazil, for example. That's where global health editor Marissa Miley went to examine the extraordinary rate of unnecessary C-sections for GlobalPost.
Marissa Miley: Around half of all births in Brazil are by C-section and that number is even higher in the private hospitals where the rates are around 80% to 90%. From my interviews with doctors and with women, it seems that there are several reasons why this is the case. I learned about this culture of scheduling in Brazil, where women want to be able to say "Well, I'll be out of town this week but my husband will be in town this week and I'd like to have my delivery on Tuesday."
Werman: So people want to be organized so they're going to schedule their birth ahead of time? That's kind of odd.
Miley: Exactly. I think there's also the perception that it's more modern and clean. Half of the number of women who felt that natural or normal childbirth was something dirty and grotesque and a doctor told us that the reason that women fear childbirth is not unfounded, really. That's because many doctors may refuse pain relief during labor process and they may not allow women to have their loved ones, their husband in the room with them during delivery.
Werman: It sounds like there are a lot of complex reasons why this is happening. It may help to put this into one narrative of a woman who's gone through this. Tell us the story of what happened just last month to this woman, Adelir Carmen Lemos de GÃ³es.
Miley: Adelir was a mother of two. She's 29-years-old and she was pregnant with her third child. Her first two children had been delivered by a C-section but for her third child she wanted to have a normal delivery, a vaginal delivery. When she got to the hospital, the doctor was really urging her to have a C-section and she did not want to have one. She ultimately went home to sort of see how the labor would progress. She described how 9 policemen showed up at her door, demanding that she go back to the hospital. The hospital had sought a court order to force Adelir to have a C-section. She did. The baby was healthy. But it really catalyzed this debate in Brazil over a woman's right to her own body.
Werman: How common a case is this?
Miley: This particular case fell to one extreme of the spectrum but I certainly spoke with a number of women who felt pressure as to have C-sections. I spoke with one woman in Recife, she's a 34-years-old. When she was pregnant with her first child, she was 39 weeks along, she was progressing normally with the labor. She had told her doctor again that she wanted a normal delivery. She got to the delivery room, was in labor for four hours, the doctor, even though she was dilated and everything was going normally, the doctor said "I'm sorry, this is not safe. I need to give you a C-section," and forced her to have the C-section despite her wishes. As she describes it, she had already had the epidural, she couldn't literally walk out of the hospital.
Werman: The Cesarean rate for the United States was a little over 4% of all births when it was first measured in 1965. Today, apparently 1 in 3 mothers gives birth by C-section in the US. So, similar trend, but what's different between the US and Brazil?
Miley: I think it's become increasingly popular for similar reasons in Brazil. I think there's an element of convenience to it but I think it's also the mentality among doctors that it's safer somehow. I know that recently American doctors came out with new guidelines trying to reduce this number because the World Health Organization recommends that the percentage of C-sections in a population be no more than 15%. Here, we have Brazil at over 50%. We have the US at around 34%. China also has a very high rate of C-sections, at nearly half. There are risks to C-sections, it's a major surgery.
Werman: Clearly a C-section is needed, it can be a life-saving procedure. It's interesting, you were doing this research while you yourself were pregnant. What's going to a place like Brazil done to change your own expectations of child birth?
Miley: I am nearly 7 months pregnant. It has made me really quite grateful of the discussions that I do have with my doctor here in the States about what I want. If my doctor says that a C-section is necessary, I think I'll want to ask more informed questions about what exactly is going on and whether or not this is indeed the right path forward.
Werman: Marissa Miley, deputy editor of global health for GlobalPost, thank you for coming in.
Miley: Thank you for having me.
Werman: Every birth has its story and we'd like to hear yours as part of our ongoing series, "The Ninth Month." We've already received several incredible submissions and we look forward to hearing more from all of you mothers and fathers out there. You can share your birth story at PRI.org/birthstories.