Driving birth: Cesarean sections and the medicalization of birth in Gran Asunción, Paraguay

• Type of Material: Article
• Authors: Tamar Goldenberg, Emory University; Jennifer Foster, Emory University; Karen L. Andes, Emory University
• Language: Spanish
• Date: 2016
• Publisher: Dirección Investigación y Publicaciones Instituto Nacional de Salud
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Dirección Investigación y Publicaciones Instituto Nacional de Salud
• Final Published Version (URL): http://www.ins.gov.py/revistas/index.php/rspp/article/view/342
• Title of Journal or Parent Work: Revista Salud Pública del Paraguay
• Volume: 6
• Issue: 1
• Start Page: 8
• End Page: 15
• Keywords: humanized birth; childbirth education; medicalized birth; Gran Asuncion; Cesareans

Abstract

Introduction: WHO recommends that cesarean rates not exceed 15%; however in 2008, 46% of births in Gran Asunción, Paraguay occurred by cesarean. The increased use of cesareans in resource-poor settings is associated with increased maternal and neonatal morbidity and mortality and high healthcare costs. The objective of this study was to understand the context in which cesareans occur in Gran Asunción. Methods: Qualitative data were collected between May and August 2010, including thirty in-depth individual interviews, twenty with recently postpartum women who had vaginal or cesarean births and ten with obstetrician/gynecologists who worked at public hospitals in Gran Asunción. A systematic analysis of verbatim transcripts identified major themes, comparing and contrasting patterns within and between interviews. The high utilization of cesareans in Gran Asunción results from a medicalized birth process that poorly prepares women for vaginal birth, routinely utilizes medical interventions without indication (e.g. artificial oxytocin, episiotomies), and does not provide social support to women during labor. Results: As a result, vaginal birth is often portrayed as a negative experience; many women consequently fear vaginal birth and “beg” doctors to operate. Some doctors also prefer cesareans because they are perceived as more convenient, controllable, and less risky for accusations of malpractice. Medicalized birth models may fail to address the emotional quality of the birth experience. Programs and policies that aim to improve maternal health should consider applying a humanized birth model because it may improve women’s perceptions of maternal care and increase desires for seeking maternal care and vaginal births.