This article was written by Daniela Guazo for investigative journalism outlet Fundación MEPI and was published on their website on September 4, 2014.
When Gabriela Ramírez found out she was pregnant with her first child, she decided to have a Caesarean section, even though she did not need it. She had heard horror stories from her mother about the three births she experienced and wanted no part of that. Like her, almost half of all women in Mexico across all social classes have had C-sections.
The country ranks fourth in the world with the highest number of C-sections for non-medical emergencies, after China, Brazil, and the United States. This procedure was designed for at-risk mothers and consists of taking the baby out with a surgical incision in the abdomen and uterus.
The World Health Organization (WHO) recommends that only one in every 10 babies be delivered via this method. This is due to the fact that performing C-sections that are not medically necessary triples the risk of death or illness for the mother and increases the risk of the infant having respiratory problems.
In Mexico, however, this practice is booming. The lack of information about natural birth options and the interests of private hospitals and doctors, who can earn high profits from having the majority of births be via Caesarean section.
Nine out of every 10 births in private hospitals and four out of every 10 in public hospitals are via C-sections, according to figures from the National Health Information System (SINAIS, according to its name in Spanish).
“The numbers are not justified”, says Dr. Christian Bayron Mera, an obstetrician and the director of the Vicente Guerrero Maternal-Children's Hospital in the State of Mexico. “80 percent of mothers could have a natural birth. And there is a higher chance of a woman having complications after a C-section.”
Gabriela Ramírez's first child was born in January 2010 via C-section. Despite what she thought, the birth was a disaster. She entered a private hospital where no one explained the process to her. “I felt like a cow. They undress you completely, they clean you, and they put a thousand things inside you. And then someone climbed onto me to press down and get the baby.” She ended up traumatized, with postpartum depression and unable to nurse her child. When she spoke up, the nurses told her, “Nothing to be done.”
“The health sector has not concerned itself with creating campaigns that inform mothers about the implications of a Caesarean”, says Xaviera Cabada from The Power of the Consumer, a civil organization.
The economic factor
Much of the increase in C-sections has to do with economic incentives because they are easily scheduled and executed. Private hospitals charge up to 100,000 pesos (approximately US$7,500) for a C-section, which amounts to a maximum of two hours work for the doctor. Meanwhile, a natural birth can require an average of 18 hours of work and costs 20,000 pesos (approximately US$1,500). The five states with the most C-sections are Yucatán, Nuevo León, Distrito Federal, Sinaloa, and Tlaxcala.
Cultural factors have also contributed to spreading this epidemic in Mexico. Extremely aesthetic images of women during pregnancy and publicity campaigns that promote an idea of how a woman's body should appear after giving birth have led many to believe that a C-section will ensure that they have the same perfect bodies that appear in the ads.
“Hollywood teaches us that giving birth means your water breaking, running out, the apocalypse stops, and the pushing starts. That is not childbirth,” says Jackie Filoteo, who has worked in Mexico as a midwife and doula, meaning a professional with experience in childbirth who helps parents during the birth.
And public hospitals?
The Secretary of Health has established a maximum of 20 percent for C-sections in public institutions. Nonetheless, 33 percent of all births in these hospitals are via C-section and the percentage increases each year. At the Institute of Social Security and Services for State Workers (ISSSTE, according to its name in Spanish), for example, seven out of every 10 infants are born via surgical procedures.
The reason for this high statistic is different among public hospitals. While it is more costly for the government to perform a C-section than a vaginal birth, the lack of beds and doctors in public institutions are the determining factor. It is estimated that there is a 50 percent deficit of beds and doctors. To attend to their entire maternal population, hospitals have to perform births quickly and the option is always a Caesarean.
If the Mexican Social Security Institute (IMSS, according to its name in Spanish), which attends to three out of ever 10 mothers that turn to the public health sector, alone would manage to reduce its practice of C-sections to one out of every 10 births like the WHO recommends, it would save more than 3 billion pesos (about US$224 million) each year. Each C-section costs the state 21,600 pesos (about US$1,600), according to the 2012 National Health and Nutrition Survey.
“Every woman needs a midwife, some need an obstetrician”
The Vicente Guerrero Maternal-Children's Hospital in the State of Mexico attends to 18 births every day, but only has five beds. Its infrastructure is saturated by the high population level that requires its services. To meet these needs, Dr. Christian has introduced a model that consists of utilizing obstetricians, midwives, doulas, and perinatal nurses. For the doctor, using these professionals is effective for the hospitals since they treat the less complicated births and the OB-GYN focuses on the high-risk births.
Jackie Filoteo is one of the doulas that works at the Vicente Guerrero Hospital. With six years of experience as a midwife and doula, she says there are several techniques to improve childbirth. For example, situating the mothers in different positions can shorten the length of the birth.
“A midwife can easily take care of all of the cases where there is no imminent risk,” says Filoteo.
Eight months ago, Gabriela had her second child. This time, she tried a natural birth. Her doula was Jackie Filoteo. Nonetheless, her situation became delicate towards the end: her blood pressure rose and a Caesarean was necessary.
Jackie, her doula, was at her side during the entire process. She gave her aromatherapy and played music in the operating room and explained every move the doctors made. “Here I felt like a human, in the other hospital I felt like a cow,” says the mother for the second time.