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Curbing the ‘Public Health Problem’ of Caesarean Births

Curbing the 'Public Health Problem' of Caesarean Births

The majority of babies born in Brazil enter the world at a time and place determined by the birth mother and her doctor. Most Brazilian births occur by caesarean section rather than live birth. There are various reasons for the growing preference of caesareans, but a new law aims to reduce what some see as an unnecessary medical procedure.

According to The Guardian, 84% of all births covered by private insurance are caesareans. In public hospitals, caesareans account for 40% of total births. Health Minister Arthur Chioro called the high number of caesarean births “a public health problem.” The government says that caesareans increase the risk of respiratory illness among infants and raise the risk of maternal mortality in childbirth.

The new law requires insurance companies to inform patients about the percentage of caesareans performed by doctors and hospitals. Otherwise, they risk an expensive fine. Doctors must inform women about the risks of a caesarean birth and direct them to sign a consent form before the procedure. Doctors must also provide justification for the caesarean, filling in a record of the labor, the birth, and the actions taken during the delivery.

Body-conscious Brazilians see caesareans as a more comfortable option that is less likely to leave the body of the woman unattractive. Convenience is another motivator as a scheduled operation is easier for patients and doctors to plan for. Some doctors also feel the procedure gives them more protection against possible litigation, gynecologist Renato Sa told BBC Brasil.

“Doctors are responsible for what happens and in a situation of risk they [choose] a caesarean, because if there is a death or complication they will be asked why they didn’t do this,” Sa said. “Doctors are afraid of natural childbirth.”

However, the high number of caesarean births is not simply a matter of choice, or even preference. The due date for a natural, live birth is an educated guess. Nature will start the process of childbirth when it’s ready to do so, with each mother operating on her own clock. In Brazil, maternity beds in hospitals are scarce. The BBC cites reports of women going into labor without a scheduled caesarean and needing to travel from hospital to hospital in search of an available bed. Due to the hospital bed shortage, many mothers see a caesarean birth as the best way to ensure they will give birth in a hospital.

In light of the fact that caesarean births are not entirely a function of choice, it’s unclear how far the new Brazilian law will go in achieving its aims of increasing live birth rates.