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C-sections as Ideal Births: The Cultural Constructions of Beneficence and Patients' Rights in Brazil

Published online by Cambridge University Press:  29 July 2009

Cecilia De Mello E Souza
Cecilia De Mello E Souza
Affiliation:
Institute of Social Medicine, State University of Rio de Janeiro, Brazil
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Extract

The culture of giving birth in Brazil has changed drastically since 1970. The caesarean section, once known as a life-saving medical procedure to be used under extraordinary circumstances, is now perceived by the medical profession and their female patients as a safe, painless, modern, and ideal form of birth for any pregnant woman. Brazil has the world's highest percentage of caesarean deliveries. The widespread use of C-sections has become a cultural phenomenon whose boundaries extend far beyond the medical arena. Medical practitioners have appropriated cultural values regarding the female body and sexuality, rein-forced a blind fascination with technology, and medicalized women's fear of labor to justify their preference for surgical births. By narrowing ethical concerns to the doctor-patient relationship and drawing on the notion of the patient's best Interest, physicians defend their practice as appropriate and even desirable.

Type
Special Section: Cross-cultural Perspectives in Healthcare Ethics
Information
Cambridge Quarterly of Healthcare Ethics , Volume 3 , Issue 3 , Summer 1994 , pp. 358 - 366
Copyright
Copyright © Cambridge University Press 1994

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References

Notes

1. Janowitz, B, Nakamura, MS, Lins, FE et al. , Cesarean section in Brazil. Social Science and Medicine 1982; 16: 19–25CrossRefGoogle Scholar. Mauad, Filho F, Urbanez, AA, Chufalo, JE et al. , Incidência de cesarianas no hospital das clínicas da Faculdade de Medicina de Riberāo Preto, USP. Revista Brasileira de Ginecologia e Obstetricia 1986; 8(5): 192–5.Google Scholar

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3. See note 1. Janowitz, et al. 1982; 16: 19–25Google Scholar. See also Barros, FC, Vaughan, JP, Victora, CG, Huttly SRA. Epidemic of caesarean sections in Brazil. The Lancet 1991; 338: 167–9.CrossRefGoogle Scholar

4. In the USA, for example, the numbers increase at a rate of 1% a year, jumping from 6% in 1970 to 15% in 1978, 22% in 1984, and 25% in 1987, according to the National Center for Health Statistics. In Europe, the rate of C-sections is between 10% and 15%, with Holland and Ireland both presenting one of the lowest rates: 5%. See note 2. Pinotti, , Faundes. 1988; 36: 73–4.Google Scholar

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10. A World Bank report reveals that $13.4 million was spent on unnecessary C-sections in 1987.

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13. After Bolivia, Paraguay, Honduras, and Haiti, Brazil leads the statistics on maternal mortality at childbirth. Fascination with technology and the proliferation of its use in less than ideal circumstances are partly responsible for such a high incidence of maternal mortality in such a relatively wealthy country. Maternal mortality is estimated at 200/100,000 live births. See Laurenti K. Morbidade e mortalidade feminina. Paper presented at the International Conference Satide da Mulher, Um Direito a Ser Conquistado 1989, São Paulo: CNDM (National Council for the Rights of Women), Ministry of Justice. Official rates are unreliable because of inadequate reporting of maternal deaths. See Simonetti, C, Cavasin, S. Relatório de síntese. Seminário Nacional Morbi Mortalidade Materna 1989, Itapecerica da Serra, São Paulo.Google Scholar

14. Most Brazilian physicians are dependent on wages. A study conducted in the early 1970s in São Paulo revealed that 80.8% of physicians maintained at least one salaried job. Only 8.4% worked exclusively in private practice. The average number of jobs a physician had was 1.8, with a range of one to five. Among the 28% who did not have a private practice, 23.7% had three or more jobs, 38.3% had two jobs, and 38% had one job. Of the 73% who had a job and a private practice, 41% had only one job and 42% had two. The average number of hours worked weekly was 52.2. Donnangelo, MC. Medicina e Sociedade. São Paulo: Pioneira, 1974.Google Scholar

15. Brazil has one of the highest rates of female sterilization in the world. See Faundes A. A ética na atenç;ão a Saúde da Mulher. Paper presented at the Seminário Nacional Morbi-mortalidade Materna 1989, Itapecerica da Serra, São Paulo. A 1986 study reported that 44.4% of sexually active women of fertile age were sterilized. The rates of sterilization vary from state to state. In Rio de Janeiro, the rate is 41%. See Pesquisa Nacional porAmostra de Domicílios. Institute Brasileiro de Geografia e Estatīstica, 1986Google Scholar. According to a U.N. report the rate of sterilization in developed countries is 7%. See Berquo, E. Sobre a politica de planejamento familiar no Brasil. Revista Brasileira de Estudos Populacionais 1987; 4: 95–103Google Scholar. Three fourths of tubal ligations are carried out after a caesarean section. See Mello, FV. Esterilização feminina e cidadania. Dados IBASE 1990.Google Scholar

16. Rezende, Jorge de. Obstetrícia Fundamental. Rio de, Janeiro: Ed. Guanabara Koogan, S.A., 1976.Google Scholar