To C-section or not to C-section...That is the question in Chile

I have never given nor witnessed a birth although I have had many discussions with women who have.  One of my favorite birthing stories comes from a friend’s mother; she’s an American woman who gave birth to five children while living in Chile in the 1970’s.  Her birthing and child-rearing stories have often been humorously discussed at family gatherings because of their intensity.  While living in a rural area of Chile, she described going into labor pains and waking her husband in the middle of the night.  He was so shocked by the news that he ran out of the house naked to get help from the neighbor.  By the time he returned, she was holding their son in the sheets of the bed; she had managed to give birth alone to a healthy baby boy with the aid of a small hand mirror—that’s right, no drugs, no doctors, no nurses or midwives, just a hand mirror.  During subsequent childbirths, she labored so quickly that her older children were called to assist in the birthing process.  As they tell the stories now as adults, it’s often accompanied with grimacing facial expressions, but I’ve often wondered if participating so closely in the birthing process had, in fact, bonded these siblings in a very special way.  I’ve also wondered if this type of home-birthing practice was common in Chile both then and today. 

As I began to research birthing practices in Chile, what I discovered was quite the opposite.  An article published in The Lancet entitled, “Health sector reform and the rise of caesarian births in Chile”, states “National statistics suggest that Chile has outstripped Brazil in having the highest reported caesarean section rate in the world” (Murray & Pradenas, (1997).  Wow.  How and why did this happen? It seems the biggest contributing factors are the restructuring of the heath care system financing by creating a private health insurance system separate from the national health fund as well as the risks doctors are facing with malpractice suits.  As more privatization of heath insurance occurred, as well as changes to the national health fund, more C-sections are being performed as a result.  Another hint toward this reasoning comes from a “Chilean forum in English for Gringos, Expatriates, and Travelers to Exchange Ideas and Information about Chile, South America” at AllChile.net,where one woman describes the risks and consequences facing doctors in the country. Kel writes that one, “should also know that in Chile, when a doc has a bad outcome, he can be taken to court. The result may not be just an award of money to the Plaintiff but the judge can send the doc to Jail. As a result many private docs require patients to sign away the right to sue for a bad outcome. Who can blame them for not wanting to go to jail? Its also a powerful incentive to practice on the conservative side.”  C-sections are also easier to schedule and complete leaving doctors with more time to include more patients in their practice.  This seems to be a cautionary tale.  As the article points out, “Privatisation and the opening up of choice in maternity care seem to have resulted in more surgical intervention at birth. As many countries plan changes in their health care financing, the experience of Chile should stand as a timely reminder that, whether intended or not, shifts in funding have the potential for enormous impact on health care practices and behaviours”  (Murray & Pradenas, (1997).

As modern women around the world continue to debate the pros and cons between natural and surgically assisted child births, I realize there are many choices to consider each one weighted with family values, culture, and education.  However I also wonder about the women who don’t get a choice.  Was my friend just lucky?

References:

Susan F Murray, Fanny Serani Pradenas The Lancet, Volume 349, Issue 9044, Page 64, 4 January 1997

doi:10.1016/S0140-6736(05)62208-8

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)62208-8/fulltext  

Kel » Sat Feb 28, 2009 12:56 pm

http://www.allchile.net/chileforum/topic1183.html