Fighting for a “normal” birth in Brazil

There are plenty of differences between life in the UK and Brazil. I’ve spoken about just a few of them in my blog so far. Many are small things of little importance, such as food and the weather. But occasionally I come across a difference that I just can’t get my head around, and today I’m going to ponder one of those: BIRTH.

I’m very excited about the impending arrival of our little one in 3 months time. As this will be our first child, everything is new to us about this process, and I only have an idea of what normally happens in the UK. I don’t wish to bash brazilian healthcare, nor to constantly compare the two countries, but I will have to make some comparisons in order to express my opinion on this subject. So here goes.

The cesarean rate in the UK is around 25%. A large portion of the population uses the public health service, and so cesareans are only conducted in emergencies, or scheduled in advance for women with underlying health issues. To request a cesarean purely out of personal choice, you would have to be under private healthcare. In Brazil, those that can afford it have private healthcare, which includes everyone except the very poorest, and somewhere along the lines it seems that the cesarean has come to be seen as the “better” way of giving birth. Whether mothers choose it or doctors advocate it because they think it is safer, easier or quicker I don’t know, and there are many other articles contemplating the reasoning behind it, but the cesarean rate here in private hospitals is currently 80-90%, sometimes even higher.

I am often asked by brazilian women if I am going to have a c-section, and when I reply with a “hopefully not”, the looks I get range from genuine shock to ‘why???’ to ‘crazy foreigner!!’. It was a similar story last week I went to visit our local, private hospital in Belo Horizonte, Mater Dei. It was a general tour for pregnant women considering giving birth at that hospital. I went along with my husband, knowing full well that most people have cesareans here, still surprised to see that I was the only of the group hoping for a birth that didn’t involve major abdominal surgery. The whole visit, for me, was an eye-opener.

The girl taking us around the facilities explained that there is the cesarean (which is in the operating theatre, exactly as you would imagine); there is the ‘normal birth’ (which also ends up in the operating theatre where the mother is usually given an epidural and episiotomy); and there is the ‘natural birth’ (which, as long as you don’t need any pain relief, can take place in one of the standard rooms with one of two doctors trained in this kind of birth, neither of which is based at this hospital). I was astounded. ‘Normal’ doesn’t sound normal to me at all. The very sight of the operating theatre had my heart racing and my husband had to pull me away.

Operating theatre at Mater Dei hospital, Belo Horizonte, Brazil

In the UK in recent years there has been a bigger shift towards natural births: a natural birth in my view involves less or no pain relief, and greater freedom for the mother to do whatever feels right, without intervention unless truly necessary. Many hospitals have separate birth centres, where you can be separated from the more clinical hospital environment and take advantage of facilities such as birthing pools to help with the pain.

I knew that to find something similar in Belo Horizonte would be more difficult, but I felt truly naive when I saw the reality. I have a wonderful, highly experienced obstetrician who speaks English, but when mentioning giving birth in any position other than lying on a bed on my back, she was noticeably uncomfortable.

Back to the tour and there were a few things that did make me laugh. The other mummies-to-be only asked questions concerning how they could be sure to get one of the bigger rooms, and how many visitors they could have. “Yes, your photographer can be present in the operating theatre” the girl said, “other friends/family can watch through the glass window.” She couldn’t answer many of my questions however, as she had never seen a natural birth.

I know that discussing births can be sensitive, and I would never wish to tell someone that having a cesarean is wrong or not the best path for them. I am, afterall, not a doctor and not experienced in any of this! I also know that the state of play here in Brazil will vary depending on where you live. Sure, I could go to a public hospital, but there the standard of care is likely to be much lower than you find on the NHS in the UK. My story is based solely on my experience so far here in Belo Horizonte, and my personal preferences. I’m no hippy and I’m not afraid to accept pain relief if I need it. What I am against is a system that has forgotten how to cater for people that don’t want surgery, to the point that most women don’t feel brave or confident enough to have a normal birth.

As I said before, I am not saying that the quality of healthcare on offer in the UK is better overall. For sure, if I wanted a cesarean or cosmetic surgery, Brazil would be the place to do it. The point I am trying to make is that the woman has OPTIONS in the UK. If she wants to avoid surgery and assisted birth, there are more experienced midwives to try and help them down that path, as long as mother nature allows, and they have the facilities for this. The focus is on what the mother wants and what is best for her and the baby, rather than being ruled by hospital policies, and what the doctor finds more convenient.

I have only visited one hospital so far, but from our research we know our options are limited. We have however heard of an institute that is pro natural labour, and we are hoping to meet with them next month to see what they can offer. I’d be lying if I said I haven’t already mentally thrown all my eggs into that basket!

I would love to hear comments from anyone who has faced similar challenges in Brazil, and in the meantime I will update you on my situation.

Related articles:

Brazil’s women rebel against c-section: Huffington Post