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The World Health Organization (WHO) warns that the rate of Cesarean sections (C-sections) have been increasing dramatically in many countries, with negative implications in the health of their populations.

Author / translator Marina Assis Fonseca

The World Health Organization (WHO) warns that the rate of Cesarean sections (C-sections) have been increasing dramatically in many countries, with negative implications in the health of their populations. Childbirth is a highly important moment in one’s personal experience, which can have an everlasting impact on the life of both mother and child. The means of childbirth is also of utmost importance in terms of collective health, since the condition upon birth is related to the immediate and future health of children, to their psycho-affective development during their childhood and adult lives, as well as to the health of the woman. The debate over childbirth involves different points of view, surrounded by myths, tendencies, and information of scientific knowledge or common sense.
What is the best means of childbirth: the healthiest or the most convenient? What should one take into account beyond safety and health risks for the mother and child: the pain, the costs, the practicality? If the economic question interferes, how should one assess the cost-benefit curve for individuals, institutions, and society? Should the means of childbirth be a choice of the pregnant woman, of the family, of the doctor, of the hospital, of the healthcare plan, or of public health policies? What is at state in this choice: autonomy, the right to healthcare, access to information, power relations, the diminishing of injury, the free market?

Created 24 June 2020
Last edited 3 August 2020
Topics Culture, Gender, Health

Policy positions

Policy position 1

The state must protect the health of the mother and child, guaranteeing access to quality healthcare during gestation and birth, regulating and inspecting public services and private healthcare plans, as well as the education of medical professionals.

Policy position 2

The state must take responsibility for medical care provided for childbirth in the public health system, and it must regulate the education of medical professionals only within public institutions

Policy position 3

The State must not regulate nor inspect, but rather promote good practices and carry out educational campaigns regarding the importance of normal childbirth.

Policy position 4

There is no need for regulations concerning childbirth. It is the responsibility of each one to choose how, with whom, and where the birth should occur, according to the pregnant woman’s preference and possibilities.

Story cards

Normal childbirth, I think it’s really mine, it belongs to the woman. I wanted it because I thought like that, that to be a mother you had to go through this, I thought I wasn’t supposed to do a C-section. I think that to become a woman you have to go through a normal childbirth and I needed to go through this experience to be become a woman, I wanted, no matter what, to have a normal birth.

Idealization of childbirth

The day that my son was born I did not hear him cry. Gabriel had a lack of oxygenation during delivery and was born with no heartbeat. He was revived by a blue-eyed pediatrician, whose eyes were red and full of tears when she gave me the news that he was not well. The first time that I saw my baby, he was intubated, on his way to the ICU. My husband and I (who saw the entire birth) stayed in the operating room not understanding the dimension of what was happening. His normal birth was dreamed of, encouraged, and praised. But he was a big baby and the internal part of my pelvis was small. He got stuck. The doctor, an experienced man, explained to me later, when the labor became complicated, that it was no longer possible to do a C-section. Result: my son almost died, and I was seriously injured. After one month, he was released from the ICU. The only part of his brain that was permanently affected was that related to motor coordination. Even though I know that what happened was unavoidable, even today I deeply regret having insisted so much with my doctor to have a normal childbirth

Maria Laura Neves, 31 years old

Normal childbirth was an ideal for me. My pregnant colleagues from Yoga used to say that we needed to “empower” ourselves, as if the power and responsibility were exclusively the mother’s. I did everything to “empower” myself. Maybe, if I had been less obsessed with this (and had obsessed my doctor less), things might have been different and I would not have become frustrated for having had a C-section. I agree that the Brazilian statistics on C-sections has to change. But no life can be put at risk in the name of this cause. Many friends whose births evolved into C-sections told with me they had the same frustration that I had. ‘I wasn’t able to have a normal birth.” This is absurd. Having a C-section is not a sin and, more importantly, it is not the mother’s fault. Children help us to see that we do not have control over everything. Sad are the women who do not understand this.

Frustrated mother (from the testimony given by Maria Neves)

My wife, Coleen, was seven months pregnant with our second child when I read an article about VBAC (Vaginal Birth after Cesarean). Our first child was born through C-section. The ultrasounds had shown that the second child was big and the C-section was scheduled. Coleen, who feared the contractions, liked the idea of a C-section. As for me, I didn’t like it: not being able to experience a “normal” vaginal birth. But it was up to her to decide. There was not, according to her, time to prepare for a radical change. Three days later, Coleen woke up at 5:00am, perplexed because she was feeling some contractions. They increased, and we went to the hospital. The cervix was with a 2cm dilation. The doctor said in a calm, but firm voice: “Since you started by yourself, you’re going to finish by yourself.” A ray of panic shone through my wife’s eyes, but we were able to calm her down. The baby was premature. About 10:30am, she was taken to the delivery room. At 11:02am, after the routine episiotomy, Coleen pushed one more time and Patrick was born, with 2.85 kg. Today, we are both happy.

VBAC

My name is Adelir Góes, I am 29 years old, and I have two children, one 7 and one 2 years old. I dreamed of having a normal childbirth in the third pregnancy. If my town had a home birth team, it would be my choice, but I would be happy with a normal hospital birth. I just wanted to avoid a C-section.
I was at 41 weeks of gestation, the baby moving around, the baby’s heartbeat and my blood pressure were normal. I went to the hospital complaining of pain in the lower back and the womb. The doctor recommended an immediate C-section as the only option. But I refused and returned home, after signing a term of responsibility.
While I waited at home, with the aid of my labor coach, the hospital called the Public Ministry, which sent an ambulance and forced me to go to the hospital. If I refused to go, armed police would take my husband to jail. He wasn’t even able to watch the birth, given that there is a Federal Law in Brazil that guarantees this right. And my rights to my body and my choices?

Adelir Góes

I did not want to have children, because I could not imagine myself as a mother. But the time was passing, and I decided to give it a chance. And I wanted the “full package”. To be a mother, it was essential to give birth to my child. Me myself. At 42 years old and my first child, I was afraid to go to any hospital and go through obstetric violence during a “normal” (abnmormal) delivery, as had happened with my mother. A C-section, no way. So I decided to give birth at home. I got informed, surrounded myself with experienced professionals. My son was born with the aid of two nurses and my husband. It was a transforming experience. In the days that followed, I wanted to have more children only to give birth a thousand times. It hurt a lot! And it was marvelous! When my family found out, I had already given birth without leaving home. I think that experience was essential to become a mother that I has never dreamed to be.

Intense and transforming

Even being an obstetrician, I ended up dedicating my career to natural childbirth. I worked as a surgeon in a maternity center near Paris. There, we changed the rules, substituting the delivery room for a room that seemed to be a room of a house. We developed a different approach for the birth, including alternatives, like giving birth in water to alleviate the pain. I defend that the woman needs to be protected from interferences that can inhibit labor. And that the baby should be colonized by his/her mother’s germs, especially when passing through the vaginal canal. I research the effects of oxytocin, which is a natural hormone that has been used, in synthetic form, in high doses during delivery.

Michel Odent

I know how to give birth, and I know that there is no need for so many interventions! But will it hurt!? Of course it will! And it is possibly the only pain that makes sense, it is the certainty that the time has come, that my child and I are ready to continue with our bond outside the uterus. I am not going to go through the shaving of my hairs, the colon cleansing, the fasting, the loneliness, the immobilization, the gynecological position, the use of artificial hormones to accelerate the delivery, and the cutting of my vagina (episiotomy), I want to feel each moment, it is my time and my choice. The C-section is abnormal, violent. Seven layers are cut, besides the chance of hemorrhage, infections, lesions to organs. I don’t want that! What is normal is natural childbirth!

Activist

Now they came up with this: a report of everything that happens before each patient’s C-section! What do they think they will improve with this? The time that I will spend doing the partogram of each patient I could being doing other deliveries. I do not need to be monitored; I studied 6 years, and I know what I’m doing; if I did not know that the C-section delivery is the most recommended for a patient, do you think I would do it for pure pleasure? Of course not, I’m a doctor, my education is on behalf of life, of health, I want the best for my patients, this is why I recommend the C-section to those that need it. The scheduling is to facilitate the pregnant woman’s life, she can schedule her life, prepare herself better. Here in the hospital, she will have all the follow-up she needs, and the risks are minimal.

C-section doctor - Partogram

We, obstetric nurses, have to look to the human being as a being that has his/her own feelings, and therefore take care of the psychological aspects, take care of everything. The humanization begins through the need to diminish the indexes of C-sections, to improve the medical care, as well as because of the hierarchical posture of medical professionals, nursing staff, and other hospital workers, who consider the woman to be in an inferior position, depersonalizing her childbirth. And even to the excess of interventions, such as medication, touch, this or that device; anyway, a lot of paraphernalia. Sometimes, the parturients get hungry or thirsty. Therefore, to humanize the birth is to revive the most natural way of giving birth, as if it were at home.

Obstetrics Nurse

After watching the film, “the Rebirth of Childbirth”, my wife and I, who is a nurse, were touched and wanted a natural childbirth. But I was afraid of a home birth. After delving ourselves in scientific articles, we were convinced about the highly favorable results of the home birth. The experience of seeing my child born in the most natural way possible (without interventions, without artificial rupture of membranes, without cuts, without episiotomy, without synthetic oxytocin) was wonderful. The human species with its millions of years of evolution does not need surgical interventions to stay alive. Pedrinho was born at home, in a bathtub, crying, beautiful, breastfeeding soon after he was born, he didn’t leave our side, he smiled! Why do we need doctors if there is no disease? As I am a doctor, I plant this seed here, in the intention to revive the original function of doctors: to take care of and treat sick people. In this we are and must, by obligation, be good.

Luciano Matarelli – Anesthesiologist and Father (Vila Mamífera Blog)

My decision has been made. I am going to have a C-section again. And I am not going to love my daughter any less because of it. This story of a natural childbirth is a “horror show” and unnecessary. I like everything organized in my life. My 1st child was born by C-section on the day that I chose. I recovered very well, in 10 days I was perfect and he was very healthy.
My doctor left me at ease and told me that I can have it the way I want again. All the births have advantages and disadvantages. What is important is that the baby arrives very healthy and perfect. Some people are criticizing me for my decision, but I prefer it like this. It will only be a normal childbirth if the electricity cuts off, if a flood comes, or I arrive at the hospital in labor. I think it’s funny that no one who chooses the C-section tries to “preach” to the others to change their opinion. I just don’t want people to judge me.

C-section woman

My name is Sandra, and I live in the town of Batalha, PI, Brazil. My first child, Vitor, I had at home, since I live far from the city. I thought I had “suffered” too much, because the pain of giving birth is terrible. When I had Gabriela, I realized that there is no suffering worse than the hospital. I spent the end of my gestation at my cousin’s house, who lives in the city, and when my “water broke”, we went to the hospital. It was terrible!!! I was “hung up” on some iron, all weird, my hips all open to the doctor, it’s embarrassing! And then I felt a lot of pain in my legs, in my foot and “in the hips”, At home, I “grabbed” the cords of the hammock hard and pulled them down, it was at least comfortable, since it was going to hurt anyway. At the hospital you don’t have anywhere to hold onto to push, the pain was worse before and after!

The positions in a hospital birth

When I went to the hospital to have my first child, I stayed for 15 hours in the delivery room, duing the waiting process, the doctor said that I could not do the C-section, but I did not have any dilation and the forceps were set up to remove my child. I do not understand the use of this procedure, especially since they say its use is prohibited; the child is put at risk with this type of delivery and I do not have good memories of my other two deliveries that I had with forceps. I’m terrified of this procedure.

Forceps

My main reason for having a C-section is to avoid the pain of giving birth. I think that if we can avoid pain, then it’s good, right?
My doctor said he does C-sectios right off because he hates to see his patients suffer. But I know women who had normal childbirths and also had C-sections, and they think C-sections are more painful. So, I’m in doubt. In the end, what hurts more?

What pain!

I will never have a normal childbirth! Humanized delivery... I don’t know what there is humanized in spending hours feeling pain, violent contractions, a big head passing through a miniscule hole, sweating and killing myself to push, tear myself or getting all cut up down there, and then the region being so sensitive and loose. If medicine has evolved so that I can give birth without pain, you can be sure that I will choose this. Now this fad from crazy nature freaks inventing risks, as if there weren’t any in normal childbirth. Compare the mortality rate in our grandparents’ day!

Fad

Never have a normal childbirth! I am a mother of 6 children, two boys and four girls, and to this day I suffer the consequence of these violent births: urinary incontinence and a hernia. When I had my first daughter, I felt absurd pains and had my vagina cut to the point of uniting it with my anus, it was immense pain, my daughter was born weighing 4.5 Kg. I was stitched up, but the stitches did not heal properly and for my second child, I had to go through the same procedure, with the added factor that I almost lost my bladder. My six children are all well, healthy, and happy, and my daughters all had C-sections, because I would not allow them to commit the same error that I did.

Listen to the voice of knowledge

INFO CARDSISSUE CARDS

Scientific Evidence versus Obstetric Practices

Some obstetric procedures performed during prenatal care, birth or postpartum are not a general consensus worldwide. Due to insufficient and inconclusive evidence, each country, institution, and/or professional adopts varied conducts for certain situations. As an example, we have the waiting time for intervention in the case of the spontaneous rupture of the amniotic liquid sac (amniotic sac breaks without going into labor).

To inform is to empower

The devaluation of normal childbirth and the practice of unnecessary surgical interventions, increasingly greater in number and frequency, are an indication of the lack of health information and education on the part of the female population. With proper information and advice, the woman is empowered and becomes the protagonist of her childbirth, making decisions according to her wishes, context, and comfort.

C-section: the best option?

Currently there is sufficient scientific evidence to affirm that no systematic and continuous diminishing of morbidity and perinatal mortality has occurred with the increase in the rate of C-sections. This surgical procedure can be considered endemic. Compared to the normal birth, in the C-section, maternal breastfeeding is more difficult; the complications are more frequent; and the prematurity, postpartum pain, and risk of death are greater.

Safety versus Fad

There are those who consider natural childbirth (NCB), and especially home birth (HB), to be a fad. Should the choice of the means of childbirth be a personal choice, subject to the influence of “fads” and personal preferences, to lifestyles? Or should there be strict regulations based on scientific evidence regarding the safest means to be born/give birth?

Responsibility over the baby: of the country or of the State?

A pregnant woman has the right to choose the means of childbirth. Medical professionals have, under their responsibility, two patients (mother and child). If the doctor assesses that the means of childbirth chosen by the mother places the baby at risk, does he/she have the right to impose the means of birth? Would a term of informed consent, signed by the patient, exempting the professional from responsibility, be enough?

Term of Informed Consent

The term of informed consent has the intention of informing the patient about the consequences that may arise from the medical act. Such a term, if used incorrectly, becomes an instrument that seeks to merely exempt the doctor from responsibilities that may arise from a medical error, and not a document that seeks to inform the patient of the possible risks, making the patient’s self-determination possible.

Term of Responsibility

A term of responsibility is the document through which a person declares that he/she has taken responsibility for a specific decision.

Normal childbirth after C-section

In Quebec, some women who had undergone a C-section, even though they wished to have a Vaginal Birth after Cesarean (VBAC), were able, through a lawsuit, to receive indemnification due to posttraumatic stress disorder. VBAC is still questioned by researchers due to the risk of uterine rupture. The literature, however, suggests that it should be attempted, since it presents a 70% success rate and a low incidence of uterine rupture.

Risks of Elective C-section

It is believed that the C-section is a means of painless and safe childbirth. However, aspects, such as severe anesthetic reactions, postpartum pain, risk of infection, mother-child separation and difficulty of link and breastfeeding, risks for future gestations such as an abnormal insertion of the placenta, are not treated when one decides to undergo an elective C-section.

C-section epidemic

The phenomenon refers to the non-compliance with WHO recommendations, which sets forth that approximately 15% of births require such an intervention, with the other 85% of low-risk gestations able to await normal vaginal birth, which has proven to be safer. Many countries have C-section rates that are far above this recommendation, where more than 50% of the total childbirths occur through surgery.

Humanized Birth

The concept of the humanization of childbirth can be quite diverse; however, there is a movement that defends it is a process that respects the individuality of the women, valuing this humanization as a protagonist and allowing for the adaptation of medical care to culture, beliefs, values, and diversity of opinions.

Pleasure x Pain

The body of the baby close to the mother’s body seems to be one single, unequivocal thing. They seemed to act in synchronicity, or better, they breathed in a harmonic cadence; they looked at each other, got to know each other, through touch and smell; they surrendered themselves passively to one another, and all the turbulence experienced in prebirth and delivery was dissipated and supplanted by the pleasure of being together.

C-section pain

C-sections are performed with anesthesia, since it is a surgery performed with invasive cuts. During the C-section, the woman feels the uterus being cut, pulled, and all its movements. Some women can feel afflicted or nauseous with this handling, but they normally feel no pain at all. However, studies do not confirm that the C-section necessarily leads to less pain, especially if we consider the pain of delivery and postpartum.

Factors linked to “C-section epidemic”

Various factors linked to obstetric professionals can be reported as forces feeding the “C-section epidemic”: mere convenience; facility in scheduling the procedure (in both private and public patients); swiftness of the delivery; fear of malpractice suits or inquiry by the maternal-infant mortality committees (the so-called defensive medicine); and ideological adherence to the C-section (belief that surgical techniques are safer).

Economic Question

Economic factors should also be taken into account. In Brazil, in the 1970’s and 80’s, the C-sections were more well-paid than normal vaginal births. This made the C-section financially advantageous for the professional and the institution in which the birth take place.

Time to give birth – Time to be born

Who might be interested in speeding up the process? During labor and birth, it is also especially necessary to wait. In a birth without interventions, the woman will realize the need to push. She does not need to be advised of this. This is not a time for risk and suffering, but rather a time for encounter.

Non-Pharmological Methods

For the WHO, it is crucial that non-pharmacological methods for pain relief be explored, as they are safer and require less interventions. Included in this are massages, free movement, respiratory exercises, and the use of water in sprinkling and immersion baths. These practices are classified by the WHO as Category C – practices in which evidence is insufficient to support a clear recommendation.

Protagonism during birth

One study that sought to understand the experience of women regarding home birth affirmed that, for these women, the births that took place at home were quick and showed a physiological evolution without interventions. Moreover, here the women were free. It is believed that nearly 40% of the births can take place outside of the hospital, be they at birth centers or at home, so long as they comply with specific conditions of safety.

Home birth

Home birth in the global scenario, in countries such as the Netherlands, Canada, and Australia, is an event that is recognized and encouraged by the public health system. In these countries, home birth is considered to be a modality of medical care that is as safe as a hospital birth; it is presented as a satisfactory experience for women and family members; and, above all, it offers a medical service that is potentially less costly for the State

Gender bias

In the interventionist model, the education model for the majority of healthcare professionals, considers the female body to be dependent on technology, fragile, and potentially dangerous to the baby. Nevertheless, studies and other care professionals consider the female body to be perfect and capable to culminate in childbirth. To what extent is it possible to wait for the physiology to act and when is intervention considered necessary?

C-section

The C-section is a wonderful, efficient, and safe resource to diminish mortality and morbidity (illness) of women and newborns when there is a medical recommendation for this. When it is recommended for non-medical reasons, or for questionable reasons, the C-section, when compared to the vaginal birth, increases the risk of the woman and the newborn to fall ill and die.

Quality of services

The concentration of neonatal deaths in the first hours of life and the frequent occurrence of fetal death at the end of gestation and during labor illustrate the strict relation between these deaths and the quality of the healthcare services provided. The high and persistent indexes of neonatal and perinatal mortality reflect the assessment of the quality of obstetric and neonatal care provided in public and private healthcare services.

Epigenetics and birth

One study reanalyzed the reports on multiple sclerosis, observing a set of different and potentially influential factors, and discovered that the C-section is one of the strongest. Those women that had multiple sclerosis, in whom it was evident, were more prone to develop it earlier on, at an average age of 24.58 years versus 27.59 years for those that had not undergone a C-section.

Fetal and neonatal deaths

One study on early fetal and neonatal deaths (479 cases) that occurred in public maternity hospitals in Brazil show that the majority of deaths occur in premature children, and low birth weight (< 2.5kg) was present in 19.2% of the births, although a high proportion of deaths (37.9%) has occurred in children with a weight of above 2.5 Kg

Gestation Period

A baby is considered a term birth, that is, not premature, when the child is born between 37 and 42 weeks. Each week that the child remains in the uterus, he/she matures and gains weight, in other words, the child prepares for its extrauterine life. The main direct cause of child deaths is prematurity (SMS, Epidemiological Surveillance Division).

Safety in Home Births

International scientific literature has shown, through recent studies, that the obstetric and perinatal results of home birth are similar when compared to the locations of birth, deconstructing the current belief that home birth presents a higher risk to the mother and child when compared to hospital births.

Reproductive Rights

The reproductive rights include: the right to decide, freely and responsibly, if one wishes or not to have children, the quantity, and when; the information, means, methods, and techniques for reproduction; as well as the right to exercise the reproduction free of discrimination, imposition, and violence.

Sexual Rights

The sexual right includes: freely living and expressing one’s sexuality without violence, discriminations, and impositions, and with full respect for the body of one’s partner; freely expressing one’s sexual orientation; having sexual relationships regardless of reproduction; the right to safe sex in order to prevent unwanted pregnancies and STD/HIV/AIDS; the guarantee of privacy, confidentiality, and high-quality medical care.

Fetal suffering

Also known as neonatal hypoxia, the “fetal suffering” occurs when the fetus undergoes periods of oxygen deprivation. This can occur at any moment in the gestation or delivery. When the fetal suffering is identified and immediately resolved, the sequelae can be minimal or non-existent. If not, this deprivation can lead to severe cerebral lesions. The cases are generally due to some form of maternal pathology or to the quality of the care provided

Complaint of neglected rights

In Quebec, if a woman is unable to undergo a Vaginal Birth After Cesarean (VBAC) without a medical justification, she is advised to complain to the hospital administration and to file a formal complaint to the medical association and the association of health and social services centers.

Rate of C-sections

According to the WHO, the rate of C-sections has nearly doubled over the past decade, especially in countries like Canada, Italy, and Spain, and has reached an extremely high level in countries such as Brazil and China. More than half of all Brazilian women have had a C-section: 55.7% in 2012.

Rate of C-sections justifications

The main justification for this reality are social, demographic, cultural, and economic factors of the pregnant women associated with the mother’s request for the type of delivery and factors related to the medical care model developed in these countries, which involve aspects of work on the part of doctors and other professionals, medical preferences, and economic interests of the actors in this process.

C-sections

The C-section is a surgical technique used to remove/extract a fetus from within the uterus. To perform the operation, a cross-sectional or longitudinal incision (a rarer solution) is made on the skin of the pregnant woman, above the pubic hair line. Seven layers of tissue are successively opened. The fetus is then taken out, and the placenta is subsequently removed. Each of these layers is then stitched.

Absolute recommendations for a C-section

The C-section has recommendation when there is:
- a premature displacement of the placenta
- prolapse of the umbilical cord
- partial or total previous placenta
- uterine tumor that obstructs the passage of the baby during birth
- baby is “sideways” (transverse, cormic presentation)
- genital warts with active lesion when beginning delivery;
- rupture of previous leakage or failure to progress in delivery.

Medical care for low-risk birth

In the majority of European and other developed countries, medical care for low-risk birth (normal pregnancy, habitual risk) is performed by professional midwives or obstetric nurses. These professionals are part of multidisciplinary teams, presenting the best perinatal and maternal results in the world, including the lowest indexes of maternal and infant mortality.

Home birth

Home births are defined as births assisted by qualified healthcare professionals and that are planned to take place at home. The planned and low-risk home birth is associated with: lower rates of severe maternal morbidity, postpartum hemorrhage, and the manual removal of the placenta; low rates of obstetric interventions with no rise in perinatal mortality rates. It presents favorable results and is considered to be as safe as hospital births.

Obstetric violence

Worldwide, many women suffer abuses, disrespect, and poor treatment during birth in health institutions. Such a treatment does not only violate the rights of these women to respectful medical care, but also threatens their right to life, health, physical integrity, and non-discrimination (WHO, 2014)

Obstetric violence II

Obstetric violence is also defined as the use of non-recommended practices during gestation, birth, and postpartum, such as: insufficient information, false recommendations for a C-section; routine intravenous oxytocin; restriction of movements during delivery; fasting during delivery; the Kristeller maneuver (pressure on the belly to push the baby out); verbal abuses, among others.

Index of Maternal Mortality

The maternal mortality rate (MMR) is an indicator of healthcare quality, directly influenced by the degree of economic, cultural, and technological development of a given country or society. MMR estimates from the WHO for 2000 identified a high risk of maternal death (MD) in poor countries, with important social difficulties, as opposed to developed countries, where this index does not surpass 50.0 maternal deaths/100,000 live births.

Index of Maternal Mortality II

Global efforts have been employed to reduce these numbers. One strategy supported by international organizations (such as the International Confederation of Midwives, The WHO, and the International Federation of Gynecology and Obstetrics) is the presence of a competent medical care professional to assist during birth. The ideal would be one medical professional per parturient.

Follow-up and control of maternities

In Brazil, where the Unified Health System (SUS) managed by local governments prevails, the health departments of some cities, such as Belo Horizonte, carry out the assessment (based on epidemiological indicators and on women’s rights) and systematic surveillance of maternities, and has even closed the doors of maternities considered to be of low quality.

The emergence of the C-section

Old records suggest that the removal of the fetus through the abdomen is a millennial practice, first performed on dead and dying women. Reports of the procedure in live women date from the 2nd century BC. The first register of the survival of a woman dates to 1500 in Switzerland, performed by Jacob Nufer, a pig castrator, on his wife. In 1851, with a publication from Francis Rousset, this type of surgery began to be considered feasible.

The emergence of the C-section II

The name “Cesarian” itself comes from a C-section birth, according to historiographic sources, harkens back to the birth of the overall leader of the Roman Republic, Julius Cesar. Cesar was removed from the womb of his mother, Aurelia, after her death. To save the baby, the professionals responsible for the medical procedures of the day had to opt to cut open his mother’s womb.

False motives for C-sections

Some false motives alleged in order to perform C-sections include: the pregnant woman’s age; the speeding up or slowing down of the fetus’s heart rate without appropriate monitoring; anemia; asthma; a single umbilical artery; a large or small baby; a poorly positioned baby; baby is swallowing amniotic liquid; “narrow” pelvis; amniotic membrane rupture; candidiasis; prior C-section, among others.

False motives for C-sections II

Some false motives alleged in order to perform C-sections include: collection of blood from the umbilical cord for freezing; umbilical cord circulation (umbilical cord wrapped around the neck of the baby); short umbilical cord; thick cervix, gestational diabetes; lack of dilation before delivery; gestation of twins; epilepsy; urinary infection; old placenta; etc.

Consolidation of the C-section

The rise in the need for C-sections first appeared in the turn of the 19th to the 20th century, due to women’s needs concerning rickets and malformations in the pelvis, along with advances in obstetrics. After World War II, the C-section never returned to its low rates prior to rickets.

The Baby’s Time 1

It is not recommended to remove the baby “before its time”, because the child needs to be ready. Many babies are still immature, though they are not considered to be premature. Prematurity is when the babies are born before 37 weeks of gestation. However, there are today studies and a broad discussion that point to the co-called “early term birth”, in which the baby has less than 39 weeks of gestation.

Imposed and unfavorable conditions

Conditions generally imposed upon the mothers in labor and which are unnecessary: Fasting; Cutting of her hair; Colon cleansing; Stay lying down; Undergo a number of touches; Administration of serum; Administration of oxytocin; Bursting or puncturing of the gestational sac; Cutting of the vagina (episiotomy); Giving birth in a predetermined position; Staying in a hospital environment.

Medical view

The issue of the patients preferring childbirth via C-section has frequently been mentioned in many studies related to medical staffs, that attribute the broad demand for the C-section to the parturients and their families, as if they were a large part of the responsibility for the epidemic of C-sections. Such a demand, however, is unfounded and cannot be sustained in light of the results of studies geared toward this question.

Endogenous vs. Synthetic Oxytocin

The effects of oxytocin on childbirth and breastfeeding have always been common knowledge. Today, we also have knowledge of its role in socialization. Studies also point to the importance of oxytocin released during delivery and normal childbirth in the formation of the bond between mother and child, in addition to its importance in the prevention of postpartum hemorrhage.

Baby Time 2

For the baby, the vaginal birth has innumerous benefits, as it represents a transition to life outside of the mother, a rite of passage. Research in epigenetics indicates that the colonization with the bacteria from the mother’s body entails protection, health, and primary prevention , The delivery time is a time for the baby to receive the mother hormones; time to descend, spin, position the head, participate actively in the birth.

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