In this South American country, elective c-sections have become almost commonplace, according to Masumi Mello e Silva, who recently immigrated to the U.S. from Sao Paolo. The overall c-section rate in Brazil is 40 percent, according to the International Cesarean Awareness Network. And if you look at only private hospitals, the rate is even higher.
There are some with cesarean birth rates of 100 percent, according to Marsden Wagner, MD, a perinatal epidemiologist who works for the World Health Organization. Private hospitals are the choice for roughly one-quarter of expectant Brazilian women, and these women hail mostly from the middle and upper classes. Trying to explain the reasons for the overwhelming number of cesareans, Mello e Silva speculates that many doctors perform the procedure in order to receive higher payments from insurance companies. Private hospitals likewise reap the benefits of higher payments for the longer hospital stays that cesarean procedures require. Also, the convenience of performing a 60-minute cesarean procedure versus attending to a long labor and delivery may lead many doctors to see the time saved as vital to their practice. In Brazil, the doctor-patient relationship is very strong -- women receive nearly all of their information about childbirth from their doctor, rather than from prenatal classes. If a woman's doctor is advocating a c-section, she may well be swayed by his opinion.
The tide is beginning to turn, at least in public hospitals, where the Brazilian government has instituted procedures to reduce the number of c-sections. In 1998 the government set a goal to reduce the public hospital cesarean rate to 25 percent or lower by 2007. To achieve this goal, the government stipulated that public hospitals with c-section rates over 30 percent would no longer be compensated for procedures they performed above that number. In 1999 the average cesarean rate in Brazil's public hospitals dropped to 24 percent, from 32.4 percent in 1995.
Local custom: According to Mello e Silva, pregnant women are treated like princesses -- for example, they are ushered to the front of any line so they don't have to wait. Once mother and baby leave the hospital, visitors flock to their home. They give a gift to the baby and receive one in return. Traditionally, it's something small, such as a bottle of perfume or candy, with a message from the baby attached thanking friends and family for the visit.