'In Brazil, we have caesarean section parties': How doctors push high-profit surgical deliveries

At a public lecture in Mumbai last week, women gathered to hear about the Brazilian movement to humanise child birth and found themselves in an uncomfortable position. After listening to horror stories of childbirth in Brazil narrated by Dr Simone Diniz from the University of Sao Paulo, the audience of mostly women acknowledged that the delivery rooms in Indian hospitals were no better.

As Diniz, who is a leader of the movement to humanise childbirth in Brazil, spoke about obstetric violence iin her country, the audience relayed their own tales of abuse. “Women are asked to clean the blood and placenta in the labour room after they are done with child-birth,” said one member of the audience.

Sangeeta Rege from CEHAT, a non-profit working in the field of health rights and one of the organisers of the lecture, said that a study conducted by the organisation found that women were subjected to physical abuse during childbirth in Maharashtra. “They would be slapped on the thighs, if the woman is unable to push in labour and slapped on the face for stopping them from screaming,” said Rege. “Verbal abuse is extremely common which discourages women from reproduction.” A Scroll.in special investigation earlier this year revealed exactly these sights and sounds from a labour rooms in Kolkata.

Physical abuse is not restricted to India and Brazil. In 2014, the World Health Organisation released a statement titled “The prevention and elimination of disrespect and abuse during facility-based childbirth” accepting the widespread problem. So far 90 organisations have endorsed the statement.

Dr Padmaja Mavani, senior gynaecologist from KEM Hospital in Mumbai and a medical teacher, admitted to the dire need for humanising child-birth in India. “Pregnancy is often looked as a disease condition,” said Mavani. “It is actually a physiological process. We [doctors] start talking about patients as bodies and organs.”

Echoing the sentiment, Dr Evita Fernandez who runs hospitals in Hyderabad said that obstetricians including her are trained in the wrong way. “We are doing more harm than good,” she said. “Women are made to lie flat on their back to deliver on uncomfortable metal beds. Performing episiotomies is a human right violation.” An episiotomy is a surgical cut in the muscular area between the vagina and the anus performed to enlarge the opening.

Advocates of safe childbirth believe that India’s rising caesarean section rates are an indication that women are not being provided with the choice of vaginal child-birth. “In Mumbai you will find that the entire building has had a caesarean section,” said Ruth Malik from Birth India, a non-profit that supports women during their birthing years. “Many women come to us asking for midwives so they don’t have to go to hospitals.”

A member from the audience who is conducting a research on the problem observed that many women are perhaps opting for abortion because of their horrible child-birth experience in their first pregnancy.

The angst among the audience was visibly high but Diniz was listened carefully to them. “This is exactly what we need,” she said. “Once women start talking about the abuse they face. They will start demanding for harm free care,” said Diniz.

Scroll.in spoke to Diniz who is travelling to different Indian states to inspire Indian women to start demanding a dignified child-birth.

According to a study published this year, India’s caesarean section rates are anywhere between 5 and 9.9%. In India, doctors said caesarean sections are overused in cities but are not available in hinterlands where they are actually required. How are caesarean sections harmful to women?
In Brazil we have cities with 100% caesarean section rates. This is not normal. Many countries especially developed economies are seeing a rise in maternal mortality rates. We have to look at the role of caesarean sections for this rise. By pushing surgical delivery, we are taking away the authority of women to choose. Technology must be submitted to human needs and not the other way round. There are many studies which have established that children born surgically have increased risk of developing diabetes and obesity.

How are caesarean sections promoted in Brazil and why women world over are choosing them?
Women are not opting for caesarean sections. Doctors are pushing surgical deliveries as they are convenient. There is no denying that caesarean sections are more profitable. In Brazil, we have caesarean section parties where relatives of the couple are invited for a buffet while the woman is delivering through a caesarean section. Everyone is celebrating the birth at pre-determined venue and time and they put a giant screen to transmit the happening in the operation theatre. They are doing everything to sell caesarean sections. No more violent delivery to sell C sections. Women are not choosing it, they are being misinformed.

Do you think India also needs a movement like Brazil to humanize childbirth?
Yes, definitely. People are very unsatisfied here. From what we heard, the problem of obstetric violence is common in India too. There are studies which estimate that one in five women are abused during childbirth. There is tsunami of many papers on obstetric violence. We have to get rid of the myth that women have to suffer to have children. Women must be able to deliver without compromising their body integrity.

How can healthcare institutes provide harm free care for childbirth?
There is an urgent need to resume midwifery programme and some countries including Brazil is doing it. Allowing companionship during childbirth is important. A woman should not be left alone in the labour room their partners need to be there as their emotional support. Also the presence of a relative in the labour room will reduce any kind of abuse that the woman is likely to face in the absence of her companion.