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Yohana de Andrade – WNN Features
(WNN) São Paulo, BRAZIL: It was a rainy Wednesday late afternoon when pregnant Ana Cristina realized it was time to get ‘to know’ her unborn son João. She went to the Maternity Hospital Leonor Mendes de Barros in hopes of an easy delivery. Despite the pain and restlessness, Ana stood quietly for four hours waiting for care. “It’s a scandal that they treat you badly,” she said. After waiting so many hours with her mother, Ana was informed that there were no vacancies and she should find another place to have her son.
She called her brother and asked for help. They would have make it across São Paulo city to go to another facility, the Irmandade da Santa Casa de Misericórdia de São Paulo, the famous teaching hospital in Santa Casa renowned in Brazil for its quality of health care, despite its enormous amount of patients.
Finally, by one a.m. the next morning Ana met her newborn son João, her first child.
Many women face the happiness of their baby’s arrival with a fear of dying, along with the desire to care for their child and also to be cared for by their medical team. They have confidence in the hospital as the safest place to have a child. But they also carry the suspicion that their delivery can be abused by impunity and deceptive medical ethics by some medical teams.
Some women OB/GYN patients hear humiliating phrases from their medical providers during the process of childbirth, such as:
“Aren’t you too old to be having a baby?”
“If you don’t shut your mouth…”
“It didn’t hurt to make it, right?”
“You didn’t close your legs then, now deal with it!”
Often women patients do their best not to complain and to follow the orders of the medical team. “I’m [working] with the contraction, I did not give a peep, I bite, I pulled my hand…” said one new mother describing her courage during her time in labor.
Traveling from the north to the south of Brazil photojournalist André François, founder of ImageMagica, an organization that promotes education, culture and health through photography, has worked to document ‘humane medicine’ inside Brazil. In the process he has also documented medical abuse. With the privilege of an exclusive ‘outside’ view as a photojournalist François created 25,000 photo images for his 2006 book “Caring,” which is now also available as an ipod ebook.
“Report for reporting [sake] is very easy and very convenient,” said François. “…For me, I think it’s important to show the way.”
Can an unwanted caesarian be a form violence against women?
In a large country such as Brazil, vast differences in the health care system do exist. A universal healthcare system set to serve the poor in Brazil was widely established in 1988 offering free public healthcare for the first time to many in need. The system has suffered under many financial strains though with crumbling medical facilities and the theft of medical supplies in over crowed medical clinics that have had long lines with services that have turned critical needs patients away. But improvements in many levels of care have been made as some hospitals have been equipped with the newest medical equipment and trained medical staff.
François saw Brazil’s system of health care up close when he witnessed the case of one woman from the Amazon who urgently needed a caesarean section. But her journey to the doctor would not be an easy one. To get the medical attention she needed, she would have to face 12 hours of shaking through intense pain as she traveled by motor canoe to the nearest medical facility. In many regions of the country “when a woman needs a caesarean section, she will usually die,” says André.
In spite of attempts to offer free health care to many of the underprivileged, a 2010 Brazilian study, “Women and Gender in Brazilian public and private spaces,” by the Perseu Abramo Foundation with the SESC (Brazil’s Social Service of Commerce) has shown that 1 in 4 women in the country suffer today from some form of abuse during delivery.
But is there a difference between abuse and violence against women during delivery? What is the perception?
“Women with lower education, do not consider that the treatment they received was mistreatment and disrespect,” says Brazilian sociologist Gustavo Venturi. “Through accounts of friends and people of the same social group, they listen that the hospital delivery is like that: it will hurt, you will scream, they will scream at you,” Venturi outlines. “There is a perception of a picture that indeed is negative, but it is seen as normal. It is not even seen as mistreatment.”
In the public hospital in the town of Ceará in northeastern Brazil there is a sign on the wall alerting patients about their human rights. It tells them that they must demand decent public medical service. At the same hospital though, another sign outlines a very different picture. On another sign is a quote from Article 331 of Brazil’s Criminal Code, known as the ‘Desacato laws,’ that prevents freedom of speech for anyone who wants to speak out against injustice, including any patient who wants to talk about their medical care.
“Desacato laws ultimately work to deter critical speech because individuals will not want to subject themselves to imprisonment or monetary sanctions,” says Catalina Botero Marino, Special Rapporteur for Freedom of Expression with the IACHR – Inter-American Commission on Human Rights.
Female patients who come from poor, rural and uneducated families often tend to be less acknowledged or counted as they become ‘objects’ in the hands of medical staff who can and do hold authority and power over them.
The World Health Organization recommends that the rate of cesarean section in a country should not exceed 15 percent. In Brazil the latest data for cesarean in most public hospitals is 35 percent. The scenario gets worse though when we consider the births covered by health insurance companies. They account for 12.1 percent of births in Brazil causing an alarming 80 percent of private hospital to use cesarean section commonly. When women are asked if they want a cesarean delivery about 70 percent of women patients say no.
“In 2002, caesarean births accounted for almost half of the total hospital childbirths in some Brazilian states. In addition to inherent risks of a surgical procedure, such as postpartum infection and risks related to anesthesia, studies indicate that caesarean birth can increase the maternal mortality rate up to seven times,” says “Brazilian Monitoring Report on the Millennium Development Goals,” a 2004 report sponsored by the government of Brazil in partnership with the United Nations.
Cesarean section, episiotomy, oxytocin and cosmetic vaginal surgery
According to medical researcher Simone Diniz, “most women go to birth without information.” Many are also convinced to accept cesarean section during labor while they are suffering from acute pain and unable to make the best decision. Women who are able to give birth ‘naturally’ are also most often submitted to episiotomy during childbirth, a medical procedure that cuts the vaginal opening enlarging it for childbirth.
“An episiotomy was once a routine part of childbirth, but the procedure isn’t always necessary,” say experts at the Mayo Clinic. “For many years, an episiotomy was thought to help prevent more extensive vaginal tears during childbirth — and heal better than a natural tear… but researchers have found that routine episiotomies don’t prevent these problems after all.”
90 percent of hospital births throughout Latin America use surgical procedures for episiotomy without any medical need or indication. Without consultation with their patients numerous doctors cut and sew the vagina to shrink it after childbirth and to ‘satisfy the husbands.’ This operation is known in Brazil as the ‘husband’s point.’ Here it should be remembered that the vagina is an organ that stretches during childbirth and returns back to relative normal size following childbirth without any cuts or surgical interventions.
The trend for cosmetic surgery following the delivery procedure is not only growing in Brazil. It can also be found in other countries, particularly in the U.S.
A medical lecture hosted by International Society of Cosmetogynecology in Orlando, Florida (U.S.) on January 26, 2010 teaches physicians who come to the conference “How the addition of cosmetic services to an OBGYN practice results in a more rewarding and profitable practice…”
The time a woman takes to complete labor in birth is another issue for medical teams who want to speed up the process. “There are reports that in some public hospitals, a woman should not be in labor from one shift to another, and all cases have to be ‘fully managed’ during the same shift,” outlines a new report by Brazilian physicians Luciano Patah and Ana Malik.
In addition to episiotomy, some women receive doses of oxytocin to enhance uterine contractions – and consequently the pain – so their delivery with childbirth is faster. But is it safe? Distinct dangers to the mother with incorrect use of the drug can cause fatal fetal hypoxia, a condition that denies a woman’s baby of life saving oxygen during the process of childbirth.