Saturday, May 18, 2013

Cesarean Cachet or Status Symbol for Brazil Women?

An NPR report this past week, C-Sections Deliver Cachet For Wealthy Brazilian Women, by Lourdes Garcia-Navarro, is available to listen to here, and a few days later, this report by Nicole Stevens was published: Elective Cesarean Sections Seen as a Status Symbol [in Brazil]. I posted the following comment on the NPR news article:

I'd firstly like to agree with the OBGYN below, that it is very important that women are advised of planned cesarean risks, and in particular, the risks of repeat surgeries. This is precisely why CDMR (cesarean on maternal request) is only advised for women planning small families. Additionally,CDMR is recommended at 39+ gestational weeks. However, the fertility rate in Brazil (as in many countries) is now less than 2, so it understandable that many obstetricians there may not be as concerned about repeat surgeries.

I'd also like to note that if comparisons are being made about birth outcomes - specifically the health and well being of mothers and babies - it is important to compare the right data. For example, perinatal mortality is more relevant than infant mortality in the context of birth. Also, Brazil's overall country rates of mortality and morbidity will be affected by different levels of maternity care and different socio-economic access to health care throughout the country (the same is true in the U.S., where wealth and poverty can often have the greatest impact on health outcomes rather than chosen birth plan). The Netherlands for example, has a very low cesarean rate but also one of the highest perinatal mortality rates in Europe. Meanwhile Greece has a comparatively high cesarean rate but ranks among the very lowest for stillbirth and maternal mortality.

While I absolutely agree that women should not be pressured or forced to 'choose' a cesarean, the exact same should hold true for women being forced to have a trial of labor - when their birth plan preference is a cesarean. The pendulum swings both ways, and I find it very disappointing that whenever countries with high cesarean rates are discussed, the knee jerk reaction is that 'these women can't be choosing CS; it must be their lazy or greedy doctors recommending it' - or worse, insulting comments along the lines of, 'well these poor disillusioned women can only be making this choice because they're not properly educated about birth'. Yet countries with low cesarean rates are automatically placed on a pedestal as how birth 'should be'.

Personally, I planned and chose a cesarean for both of my births, and don't have a single regret about that choice. However, I don't criticize other women who make a different birth plan choice than my own, and I have no ideological bias towards increasing CS rates - but the same cannot always be said about advocates of birth with as little intervention as possible. I suggest we listen to all women - properly - and not always assume that we know what's best for everyone. Many, many women happily choose a cesarean birth, and it's about time people everywhere got used to the idea and stop trying to vilify this legitimate choice.

Finally, reproductive choice has evolved on so many levels in recent decades, and yet whereas no one would ever dream of asking me what birth control I'm using or if/when I started using it or whether my baby's conception was planned/unplanned, natural or assisted (and socially, people don't seem to mind what the answers to these questions are anyway), when it comes to my birth plan, reactions to my cesarean choice have ranged from shock and disbelief to outright anger and disgust. But as the woman in the NPR interview says, "In the end, it's my choice", and I couldn't agree more.

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