Before we are mothers we have to face what seems to many like a seven-headed beast that comes down to the question: normal or cesarean delivery? Influenced by our own mothers, friends, doctors and information from the media, each of us defines her birth preference. But are we well informed and, more importantly, is our will respected ?
To find the answer, we conducted a survey with 1011 visitors to the Changing Diapers, which revealed that 73% of Brazilians prefer normal birth while 27% opt for cesarean. Comparing this result with the birth statistics of the Ministries of Health, it is clear that there is something very wrong here. Almost 57% of the 2.9 million brasileirinhos and brasileirinhas born in 2013 saw the light for the first time through cesarean delivery. This percentage has been steadily increasing for decades and makes Brazil the world champion in this category.
According to information from the World Health Organization, cesarean delivery is advantageous and therefore necessary for the health of the mother and baby in only 15% of deliveries. Counting women who prefer normal birth, but who need to do the opposite way out of necessity, and assuming that every woman who prefers caesarean delivery can do it, the rate of cesarean sections should not exceed 38% under any circumstances. This means that almost one in five Brazilian women has their will disrespected , that is 19%. Even in SUS, where the rate has passed 40%, there is an excess. To add up to the national average, we can only conclude that the excess in the private network is much higher, approaching 90%.
The Origins of the Increase in Cesarean Births
A starting point for identifying the origins of this problem was not difficult to find – my own birth history. The question “cesarean or normal delivery” always had a simple answer for me: I wanted to have a normal one! Do you know what ended up happening? None of my three children were born by normal birth . This does not mean that I was completely disrespected because in the cases of my girls it was inevitable. Joana’s delivery was emergency even because she had no more amniotic fluid and a serious infection was already taking place. In the case of Melissa it was the result of pre-eclampsia that could lead to high and dangerous pressure, not to mention the risk of eclampsia in a possible new pregnancy that would be full of risks for me and the baby. So, understandably, the doctor opted for a cesarean section.
Now, Eduardo’s delivery was different. There was no need and it was possible to do it in a normal way. But that became clear to me only much later in the conversation with another obstacle. I arrived at the maternity at 9 am with 41 weeks of gestation. The symptoms of labor had started some time ago, but nothing about Dudu wanting to leave. As I wanted to be normal, the doctor started to encourage childbirth. While liquid was leaving, because the bag burst, the expansion did not increase. In the afternoon, the obstetrician made the decision, without informing me, to have a cesarean delivery, saying that my baby would not pass through the vaginal canal. Today it seems to me that there was another reason that also influenced: the convenience of the doctor to avoid complications and close his shift on time. But what was I going to do?
As you can imagine, the doctor has a crucial role in deciding whether it will be a normal delivery or a caesarean. In addition to convenience, cesarean delivery has another advantage, both for the doctor and the patient – it is planable. On the side of pregnant women, this is manifested as the second most cited reason for this type of delivery. For clinics, the explanation can be economical, especially considering the fact of the very high rate in the private network. It is possible to earn X value in Y time – a marvel from a profit standpoint. Assisting a normal parturient for several hours is simply less attractive and also more practical from the professional’s point of view. The doctors’ reasons for cesarean delivery are also reflected in the recommendations they give to their patients – a reason also cited by the participants in our survey.
Weighing more in the argument against normal childbirth is pain . And who is not frightened by the thought that a whole baby has to go through the narrow vagina? Just by the look test and the scenes on television, it seems that you can already feel the pain, without counting the comments of friends, mothers, women who went through the experience without pain medication. But have you ever thought that mental simulation of pain size can be stronger than real pain? The female body has all the capacity to give birth to a child in a natural way. This does not mean that normal childbirth does not hurt because it does, but to really know it is necessary to know, each woman feels the pain of childbirth differently.
The “worst” moment is strong contractions, which can not be avoided completely with skin anesthesia, and not so much the moment when the baby is leaving. It is also possible to reduce pain during childbirth with psychological and physical preparation. And finally what many women do not remember when they think of the pain of normal childbirth, that cesarean section despite anesthesia also brings pain – in the postpartum period. Recovery time from cesarean delivery is typically a few weeks, while some vaginal women can walk and care for their baby on the same day.
Myths About Normal Childbirth After Cesarean
The question “normal or cesarean?” it does not exist only for the first delivery, but it can and should be present in all births. While it is widespread that a woman who has had a normal birth can have a cesarean section or the other way around it is a big myth in the lives of many women. They believe that they cannot have a normal delivery after cesarean section. Women who had their first cesarean delivery may have a normal delivery in a new pregnancy. Typically, the most commonly used excuse for second-time moms involves the condition that it previously happened to the surgery. But no, normal delivery is perfectly possible after cesarean delivery.
Normal delivery is also possible in a third pregnancy with two caesarean sections. However, this involves greater care by the obstetrician who takes care of the pregnant woman. Theoretically, any sign of labor would bring a greater risk that the scars from previous cesarean sections will rupture because the cut already stretched by the current pregnancy would become fragile. But still, yes, vaginal delivery is possible. It is just not advisable to have a normal birth at home and before the term after two caesarean sections, as devices will be needed for any eventuality. The woman must also be in good health and have a controlled pressure for labor to happen normally.
To have a safety parameter, caesarean delivery can happen at most three times. From the fourth, the risks related to the pressure exerted on the scar increase significantly, putting the pregnancy in general in danger. On the other hand, normal birth can be done several times without limitations. We look at the example of women from past times who had 10, 12 or sometimes even more children when fertility allowed.
Preferences and Differences in Normal Childbirth
While the caesarean delivery woman is completely delivered into the hands of the obstetrician, this is not necessarily the case for normal delivery. Two-thirds of the participants in our survey expressed the desire to have a delivery different from the conventional performed in maternity wards in the country, namely, humanized or natural. For the purpose of analysis, the following definitions of normal birth are understood:
- Conventional – performed with medical intervention already scheduled before delivery
- Humanized – performed with intervention only with the express will of the parturient
- Natural – performed without any intervention
Currently, there are no conclusive statistics on humanized and natural births in Brazil. Even supposing that some women were not 100% aware of these definitions at the time of responding and there are changes of opinion until the moment of delivery, it is not necessary to know all Brazilian maternities that the reality is far from Brazilian women. Certainly, less than 31% of normal births are humanized even due to a lack of preparation by the respective institutions for this.
Thanks to the mobilization of Brazilian women to demand the right to have their will respected, to the greater diffusion of the theme in the media (as in Youtube for example) and the consequent increase in attention, there are signs that this situation may change. More and more maternity hospitals are willing to follow the example of reference institutions to support women and enable their free decisions.
How to Have the Right to the Childbirth I Want
I consider a happy ending, a delivery that goes well, that ends mother and baby in full health and that has the will of the respected woman. We saw by this research that mainly the last aspect is still far from reality. Yes, many women wanted to have their best time in life naturally, as did their mother, grandmother and great-grandmother. For this, it is important that professionals are aware of what is best for the patient and her baby and be open to listening to you. Talk to the obstetrician who will likely monitor the delivery in advance about possible forms of delivery, your fears and desires. If you are in the happy situation of being able to choose (and I know that many women cannot for lack of choice), look for an alternative when you don’t feel the perfect fit.
Cesarean delivery certainly saves lives, but there are many, many cases in which it is totally unnecessary, especially in forced situations with irrelevant and totally opportunistic excuses. It is no accident that Brazil leads the world in cesarean sections. The hope is that the initiative taken by the Federal Government , which obliges doctors under penalty of a fine of R $ 25,000 per occurrence to justify their choice of cesarean delivery, strengthens the position of us patients. As the woman has all the confidence, the doctor in turn could suggest normal delivery, why not? There is no doubt that it is better for mother and baby, because at birth vaginally, the secretions are expelled through the cervical canal, in addition to, of course, favoring postpartum for the mother.
In order to have a normal delivery, the conditions must also be favorable. To have a humanized delivery , it is often beneficial to have a delivery plan. In addition, you need a doctor to welcome you 100% because without it, childbirth will never be as the woman imagines. As tranquility is fundamental at this moment, trust in the professional who accompanies us is the most important. This is also true for home birth.
But it is not only the external factors that decide whether delivery will be the one dreamed of. We need to be prepared psychologically and physically. For a normal delivery, the woman can eat properly and exercise daily to facilitate dilation, not gain too much weight during pregnancy and avoid severe health problems. With the proper clearance of the doctor, the woman who intends to have a normal birth can do swimming, yoga and pilates. If you are an athlete before pregnancy, the pace should be reduced.
My name is Dr. Alexis Hart I am 38 years old, I am the mother of 3 beautiful children! Different ages, different phases 16 years, 12 years and 7 years. In love with motherhood since always, I found it difficult to make my dreams come true, and also some more after I was already a mother.
Since I imagined myself as a mother, in my thoughts everything seemed to be much easier and simpler than it really was, I expected to get pregnant as soon as I wished, but it wasn’t that simple. The first pregnancy was smooth, but my daughter’s birth was very troubled. Joana was born in 2002 with a weight of 2930kg and 45cm, from a very peaceful cesarean delivery but she had already been born with congenital pneumonia due to a broken bag not treated with antibiotics even before delivery.