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Brazil: The Debate About Natural Childbirth

In Brazil's private sector, over 85% of births are caesarian, even though the World Health Organisation previously recommended that caesarians not exceed 15% of total births. Brazil is right behind Chile in the list of countries that most frequently carry out this surgical procedure.

The high prevalence of this procedure instead of natural birth, recently sparked a debate and protest in Brazil, which involved activists from organisations such as the Parto do Princípio [pt], who are opposed to childbirth being dictated by health insurance plans. At the protest, activists shouted: “Doctor, you don't fool me. Caesarians are [to] make you rich”.

The Home Birth March [pt] was held in four of the country's regions following criticism of the Regional Council of Medicine of Rio de Janeiro (Cremerj) towards Dr Jorge Kuhn, the coordinator of the obstetrics department at the Federal University of São Paulo, who had spoken in defense [pt] of home births. Kuhn claimed that childbirth was a physiological, not medical process.

Criticism of the doctor provoked men and women to mobilize themselves in defense of the right to choose where one gives birth. On June 17, 2012, the march took place in Brazil's state capitals: Belo Horizonte (MG), Brasília (DF), Curitiba (PR), Florianópolis (SC), Maceió (AL), Porto Alegre (RS), Recife (PE), Rio de Janeiro (RJ), Salvador (BA), São Paulo (SP) and Vitória (ES).

Mothers, sons, fathers, grandparents, students and activists took to the streets to defend natural childbirth in Brazil. Upon arriving at the Mário Covas park on the Avenida Paulista (Paulista Avenue) [pt], São Paulo, you could see children painting posters which read: “I chose the time and place of my birth,” from afar.

Manifestação pelo parto em casa em frente ao CREMESP, São Paulo, 17 de junho, 2012. Foto da autora.

Protest for home births in front of CREMESP, São Paulo, 17 June, 2012. Author's photo.

While women were marching in different states in Brazil, there were – and still are – some people who considered Dr Jorge Kuhn's attitude to be unprofessional, highlighting home birth fatalities as proof of the risks involved in this practice. This stance was adopted by regional boards of medicine, including Cremesp in São Paulo, where about 1,000 protesters marched.

In contrast to the protests, is the prevalent mistrust in home births. A large proportion of the Brazilian population do not have adequate living conditions. On the Facebook page for the Home Birth March, Amélia Araújo asked [pt]:

Parto em casa? E as mulheres que moram na periferia sem as mínimas condições de higiene e saneamento básico? E a equipe de saúde irá enfrentar o tráfico? Que tal o parto humanizado no hospital?

Childbirth at home? What about the women living on the margins, who do not have basic hygiene conditions and sanitation? Would health workers brave the traffic? What about natural birth in [the] hospital?
Florianópolis, SC, 16 de junho, 2012. Foto de Marcha pelo Parto em Casa no Facebook (usada com permissão)

Florianópolis, SC, 16 June, 2012. Photo of the Home Birth March on Facebook (used with permission)

Fear of home births [pt] is still prevalent among Brazilian women and the Committee of Obstetric Practices highlights that natural birth in the hospital is the best and least risky option.

Nevertheless, the reality of giving birth in Brazil's public – and especially private – hospitals does not correspond to this ideal because obstetric violence is one of the greatest acts of disrespecting the rights of Brazilian women. The results from the collective blog initiative, The Obstetric Violence Experiment, which was published [pt] by the Childbirth in Brazil organisation, revealed verbal abuse as a phenomenon constantly experienced during labour, thus proving the dehumanising aspects in the health system in Brazil.

The lack of information due to the precarious pre-natal services in many Brazilian regions is another obstacle towards implementing practices that respect the woman's right to choose. Government programmes such as “Mãe Paulistana” [pt], which was implemented in 2006 in the municipality of São Paulo with the aim of supporting pregnant women throughout their pregnancies, represented progress in the increased attention paid to maternity, but it is still far from becoming general public policy.

In contrast to the lack of attention paid by leaders and the neglect present in health insurance policies, the participants at the march defended the right to choose based on scientific evidence, so that natural childbirth in Brazil might become a possibility.

For the participants, respect for woman's independence should exist in the home as well as in hospitals, and home births should only take place in environments with adequate sanitation, for those women who do not have gestational complications and are therefore low risk. It would be wonderful to let the warrior woman's body act naturally, to follow her instinct, allowing us to share that special moment with her.

  • Lillianbondo

    It seems to me, coming from a country that also seeks to fight high levels of cesarian sections, albeit ‘only’ at 21%, that Brazil must find the strength of midwives and to a much much higher degree utilize the potential in a group of well educated midwives, working evidence based (apparently apart from Brazil’s majority of medical doctors, who seem to have forgotten the Hippocratic oath id they ever took it: first, do no harm!)
    With midwives to offer antenatal profylaxis, assist at birth, cowork with doctors when the woman or the baby needs the help, you stand a chance of turning the development. But for years to come, Brazil will feel the burden of obstetric invalids. Now! Is the only option of time to alter!
    Lillian Bondo, midwife, MPA, president of the Danish Association of Midwives

  • http://www.johotheblog.com dweinberger

    Thanks for this interesting post on an important topic. But could you please clarify what “private sector” means in this context? I don’t know enough about Brazil’s medical system.  Thanks.

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