Opinion, by Rachel Brabbins

RIO DE JANEIRO, BRAZIL – Making the decision to have a baby outside of your home country is overwhelming, but when that country has the second highest rate of Cesarean sections in the world, the stakes are somewhat higher.

This is the reality of expatriates living in Rio de Janeiro today. In fact, 61 percent of all births in the cidade maravilhosa are performed by C-section. To put this into perspective the World Health Organization (WHO) recommends a maximum C-section rate of fifteen percent for optimal maternal and neonatal outcomes.  

Many health experts warned of a “C-section epidemic” in Brazil following a rapid rise of around twenty percent between 2000-2014 which, understandably sends chills down any prospective mother’s spine, after all epidemics are never a good thing.

When you combine this with Brazil’s vastly unequal two-tier healthcare system; massively overstretched public healthcare versus extortionate and occasionally exploitative private healthcare, birthing options are, to put it bluntly, a minefield.

There are a whole plethora of reasons for the surge in Cesarean sections in Brazil; women are not given the adequate information about the pros and cons of natural births vs C-sections and are often told the latter are easier, quicker and less painful.

Also time is money and in the private healthcare system doctors can fit in more Cesareans, women who are more body conscious often opt for C-sections and unfortunately, good old chauvinism (machismo) plays a part too because of the myths surrounding vaginal births.

Then, what follows is that doctors become more adept at performing C-sections and neglect learning how to perform natural births, creating a vicious Cesarean cycle.

Having discussed the “C-section epidemic” with many friends, acquaintances and experts in Rio de Janeiro, I heard a multitude of birthing stories, from the horrendous accounts of what was verging on obstetric violence and forced C-sections to successful home births and comfortable public hospital vaginal births.

These experiences mirror those I heard in my native United Kingdom – every woman, every pregnancy and every experience is different. However, the contrast here in Rio is that pregnant families HAVE to do their homework, no information is handed to you on a plate and, yes, there are fewer hospitals, practitioners and experts in natural births to call upon.

But the most important fact is that there IS a choice.

Women in Brazil are now more aware of the benefits of natural births and it seems as though the tides are turning, albeit slowly. In 2015 a new law came into force aimed at reducing the number of C-sections, which makes it mandatory for doctors to inform women about the risks and ask them to sign a consent form before performing a C-section.  

Private healthcare, which has a staggering 85 percent C-section rate, way above the 45 percent average in public hospitals, is also attempting to change its practices. The National Supplementary Health Agency (ANS) launched an Adequate Birth program three years ago, a set of guidelines aimed at improving birthing practices and reducing the number of Cesareans.

The most recent initiative from the Ministry of Health is the Apice-On program, which really cuts to the heart of the problem, improving clinical training in obstetric and neonatal care based on patients’ rights and humanization.

Brazil’s Cesarean culture will not be cured overnight and many women will find themselves on a hunt for that elusive natural birth doctor.  Expatriate families here in Rio have a range of public and private options; a rise in women opting for home births has increased the number of midwives and doulas and, although these are not covered by health insurance, they are often more affordable.

Maria Amélia, the public maternity hospital in the center of Rio has a good reputation for vaginal births and there are also a whole host of private obstetricians who specialize in natural births, some of which also speak English.

Forced and elected Cesareans in Brazil are commonplace. Fact. The statistics and the stories don’t lie. But there is an alternative. The “C” in C-section does not stand for convenience, they are life saving operations that have dramatically reduced child mortality.

The most import “C” word for pregnant women in Brazil should be choice and this needs to be supported by all of those involved in her journey; doctors and doulas, family and friends and the government.

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