New Brazil rules seek to cut Cesarean craze

New regulations aimed at rolling back Brazil's obsession with Cesarean sections took effect Monday, with the government hoping it can steer the country from its status as a world leader in C-section births.

The rules and a campaign called "Childbirth is normal!" address what Health Minister Arthur Chioro has dubbed an "epidemic" of Cesareans, currently accounting for more than half of births in this nation of 200 million.

About 84 percent of Brazilian mothers on private health care undergo the operation, in which the baby is delivered through a small incision in the mother's abdomen—often for no other reason than the convenience of being able to choose the date.

In public hospitals, that figure is approximately 40 percent.

This still tops the 32 percent rate in the United States and is massively higher than World Health Organisation recommendations of 10 to 15 percent.

Brazil's new rules require doctors and hospitals to share information with patients, notably the number of Cesareans they have already carried out.

When they fail to give requested information, the health insurance companies face fines of up to about $8,000.

Making patients better informed will help diminish the rush for C-sections, health officials say.

"Childbirth is one of the most important moments in the life of a woman and her family," said Jose Carlos de Souza Abrahao, director of ANS, a specialized health ministry agency.

"By informing her of the risks that could come with an unnecessary surgical procedure, she will be more sure in her decision regarding the delivery, choosing what's best for her health and for her baby's health."

Mothers mean money

Mass Cesareans are Brazil's "international shame," pediatrician Luciana Herrero told AFP.

Ignorance and desire for convenience drive Brazilian mothers-to-be to the operating table, said the author of the just published book "Diario de Bordo do Parto," or "Guide to Childbirth."

But Herrero echoed many in Brazil, saying that "encouragement" by doctors and hospitals is also to blame.

Even when fees for a Cesarean and normal birth don't vary, the surgical option is still more profitable for hospitals because it can be scheduled to the minute and has little of the unpredictability—and possibly long working hours—of natural labor.

Rosana Clein, a 37-year-old marketing manager in Rio, wanted to have her son naturally three months ago. At the last minute, due to pain, she had Tom delivered by Cesarean.

Even well before, though, when she was insisting on keeping things natural, she felt pressured.

"I tried to find a doctor who was supposed to do a natural birth like this, but in Brazil it's not so easy. They try to convince you the best way is to do a Cesarean. They say you're going to have a lot of pain the natural way," she told AFP.

"For the doctor, it's really easier to have the Cesarean. You can book it and you have your agenda. It's not a question of saying, 'Go to the hospital now in the middle of the night.'"

Changing the culture

Cesareans may be convenient but they can also be dangerous for the mother and potentially pose grave future health consequences for the baby, ranging from an increased risk of obesity to chronic illness.

Herrero applauded government attempts to make women better informed.

"Knowledge is power," she said.

"Seven out of 10 Brazilian women begin their pregnancy intending to have a normal delivery, but barely half of them do so.

"I wonder how many of these women changed their mind during their pregnancy, how many had a real medical reason justifying surgery, and how many were persuaded unnecessarily to have the Cesarean?"

But the latest government effort is still insufficient.

"I believe the solution must include other sectors of society and be discussed openly with all involved... so that together we can put births in Brazil onto a new path," said Herrero.

Clein said that after speaking with many other expectant and new mothers over the last year, she feels change is already happening.

"There are a lot of women trying now to have the natural way. They're talking a lot about it, that it's good for the baby, just in the same way that they say breastfeeding is good for the baby."


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New rules to curb 'epidemic' of cesarean births in Brazil (Update)

© 2015 AFP

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