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Ricki Lake

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Birth in Brazil

Posted: 05/07/2012 10:56 am

When we were filming our 2008 documentary, The Business of Being Born, my director Abby Epstein made several trips to Rio de Janeiro, Brazil. We both became very interested in Rio because it sounded like a place where normal childbirth was being phased out. The statistics we heard were mind boggling -- 93 percent of all babies born to middle and upper-class parents were delivered via cesarean section. Some private hospitals in Rio had an even HIGHER C-section rate than that -- closer to 98 percent! There was actually a joke circulating that the only way to have a natural birth in Rio was if your doctor got stuck in traffic. We shot some fascinating footage, but in the end Brazil was left on the cutting room floor as we decided to focus The Business of Being Born on birth in the U.S.

Five months ago, Abby and I released More Business of Being Born, our four-part follow up series to BOBB. We returned to film in Rio and were able to include a segment on it in MBOBB: Explore Your Options: Doulas, Birth Centers and C-Sections, which The Huffington Post will be streaming free to the public tonight, May 7 at 5 p.m PST/8 p.m. EST. Click here to watch.

There are a myriad of reasons why cesarean section came to be the preferred method of delivery for middle class Brazilians. First off, there is a pervasive and deeply rooted fear of the pain of childbirth handed down from older generations. The cultural fear is so intense that many Brazilian women are terrified of experiencing even the slightest contraction and believe that a vaginal birth will damage their bodies irreparably. Secondly, the physicians and pediatricians do not practice in groups and must be on call for their private patients 24/7. Clearly, that is almost impossible for any human being to achieve unless the births are all scheduled.

Lastly, most of the current generation of obstetricians believe that cesarean delivery is safer than vaginal delivery and not only impart this philosophy to their patients but also refuse clients who are considering a vaginal birth. We were surprised to discover that many of the mothers we interviewed had actually wanted a normal birth but ended up agreeing to a physician-advised cesarean at some point during the pregnancy. Often the cesarean is mandated for vague and benign reasons like an umbilical cord around the baby's neck, which occurs in one-third of all births and normally poses no risk.

Returning to Rio five years later, there is more awareness about the impact of performing so many cesarean surgeries, such as higher rates of maternal morbidity and more premature babies. The natural birth movement is also growing stronger and succeeding in many ways, but the culture does not seem poised to embrace normal birth anytime soon. Essentially, anyone with financial means chooses to deliver their babies via cesarean section without question.

I hope you will join us for the screening tonight: May 7 at 5 p.m. PST/8 p.m. EST followed by a live Q&A with me & Abby at 6:30 p.m. PST/9:30 p.m. EST. Click here to watch it on The Huffington Post.

If you can't catch the whole film tonight, you can see it at www.thebusinessofbeingborn.com.

Check out our Mother's Day Special Offer! A free extra set of films for a mother-to-be.

 
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When we were filming our 2008 documentary, The Business of Being Born, my director Abby Epstein made several trips to Rio de Janeiro, Brazil. We both became very interested in Rio because it sounded l...
When we were filming our 2008 documentary, The Business of Being Born, my director Abby Epstein made several trips to Rio de Janeiro, Brazil. We both became very interested in Rio because it sounded l...
 
 
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HUFFPOST SUPER USER
Antidiot
01:21 PM on 05/22/2012
Well then Giselle should be an important positive influence then.(I know she lives in Boston, but she blogs in Portuguese.):

http://www.giselebundchen.com.br/

She is an outspoken advocate of both natural birth and breastfeeding.
05:10 PM on 05/08/2012
I don't understand the obsession with "birth experience," and yes, I'm a mom and a feminist.
Both cesarean and vaginal deliveries have risks, pros and cons. Each woman should be free to decide, what option she prefers.

Elective cesareans seems far preferable to emergency ones. If a woman fears childbirth, or has medical issues that increase the chance of birth complications, why not go for the scheduled c? It's good to live in the developed world and have choices.
11:07 AM on 05/09/2012
The obsession with the birth experience is based on the fact that, absent people like Ms. Lake advocating for alternatives, the system devolves to a medicalized norm i.e. caesareans and inductions. If you've ever tried to choose an alternative, i.e. natural (which is the norm in many developed nations like Holland) in the US you find out quickly that choice is an illusion. Despite stronger outcomes, hospitals/OBs/health insurance providers stick with a formula. Midwives and OBs who support true choice are forced into becoming advocates for a form of birth that almost disappeared in the US by the late 1960s. One of the main reasons is the financial incentive - hospitals, anesthesiologists, and OBs themselves make very little money from natural birth. Birth is of the best ways to get otherwise healthy non-consumers of medical services in the door.
HUFFPOST SUPER USER
anti politricks
better to light 1 candle than curse darkness
12:33 PM on 05/08/2012
business of being born: must watch for all women.
HUFFPOST SUPER USER
blondecuban
01:53 AM on 05/08/2012
This is such a sad commentary about a society rooted in superficiality and physical beauty. Both Argentina and Brazil will deny women employment if they are not what is considered physically beautiful. In addition, they both have extremely high plastic surgery rates, where in Brazil those procedures are covered by medical insurance. So physical beauty and convenience is more important than the health of the baby. These crazy woman are not considering that the c-section requires cutting through the abs, which weakens them permanently. Doctors are only concerned with scheduling birth procedures so that they aren't inconvenience by them while having dinner or sleeping. Obviously, they chose the wrong profession.
08:20 AM on 05/08/2012
Where did you get the idea that medical insurance covers plastic surgery in Brazil? no, it doesn't.
08:23 AM on 05/08/2012
People will be denied employment based on their looks pretty much everywhere in the world, for instance, just have a look at Wall Street.
However, it depends on the job. No one will deny a teacher a job, regardless of how they look. A nurse, a doctor.
Please, get your facts right. What about bringing statistics to prove your point?
01:23 AM on 05/08/2012
The US has a high rate of c-sections and it's not mentioned in the article. My understanding is that it's a malpractice issue with doctors.
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HUFFPOST SUPER USER
peacefuldaizy
Be the change you want to see in the world
04:26 AM on 05/08/2012
Our rate is NOT 95%
10:40 AM on 05/08/2012
It's 34% and increasing. You would think it would be mentioned for comparison.
HUFFPOST SUPER USER
backwaterbandit
11:04 PM on 05/07/2012
society, civilized society, has gone to hello in a cheap, made in china, handbag.
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gravityhunter
Lock, wave n pull
09:54 PM on 05/07/2012
I know a person who had a c-section due to the possibility of the vaginal cavity never recovering to it's normal size......a reason I do not see mentioned anywhere in the comments section. Are there others that consider it for this reason or is she alone in her reasoning?
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HUFFPOST SUPER USER
peacefuldaizy
Be the change you want to see in the world
04:27 AM on 05/08/2012
I've read that some women have it b/c of that fear and and vaginal tearing. I got news for them. It returns to normal ...
11:15 AM on 05/09/2012
What's normal size? I have plenty of friends who have had 2-4 children and can still wear a tampon. Of course, you might not have the vagina of a 16 year old and you can't get a tummy tuck at the same time as you can with a c-section. Yes, having babies does change your body. Having kids changes your soul. If you let it. That's kind of the point.
09:35 PM on 05/07/2012
I have heard from a colleague, who is from a third world country, that doctors push c-section over there to make more money. They make a ton more money by c-section than just good old natural birth. Anyways that is what he said and I guess when you are in the hospital bed, writhing in pain, you can't take a chance that the doctor is saying it because of actual danger or just to pad his fees and just go ahead and do it?
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HUFFPOST SUPER USER
indy100
Wise up
07:52 PM on 05/07/2012
While such high C-section rates don't sound right, as someone who had four C-sections myself I know there are valid reasons for them. I won't go into personal details, suffice it to say there was a valid medical reason. Also, you blithly mention the umbilical cord being wrapped around the baby's neck as "normally posing no risk" It's true that the cord is wrapped around the baby's neck about 25% of the time, however I'll disagree with your assessment of "no risk" until the day I die. My fourth granddaughter was born still because the umbilical cord was wrapped tightly around her neck TWICE. Unfortunately we didn't know this until she was born. And her little sister, granddaughter #5, was also born with the cord wrapped quite tight around her neck. I was there for both births, and I watched as they monitored the baby's heart rate even as she was being delivered and saw the doctor in panic (aware of my daughter's previous loss) stop everything and cut the cord before her shoulders even came out. Vaginal births definitely carry their own risk, to both mother and baby. In fact even in 2012 pregnancy itself is a highly risky event, a fact I learned the hard way. Even today 1 out of every 115 babies is born still, even today mothers die in childbirth.
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HUFFPOST SUPER USER
peacefuldaizy
Be the change you want to see in the world
04:29 AM on 05/08/2012
She did not say it poses no risk. She said: which occurs in one-third of all births and normally poses no risk. Each case should be assessed ... My daughter was born with the umbilical cord around her neck and is fine. Each case must be evaluated and assessed independently.
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HUFFPOST SUPER USER
indy100
Wise up
07:38 PM on 05/08/2012
You are lucky, I'm happy for you. Many others are not so fortunate however. And there is no such thing as "normally no risk" in childbirth. I foolishly used to think that also, but research has taught me otherwise. And yes each case must be assessed independently, which is why I tire of reading/hearing the chants of women about vaginal birth as the end all and be all. Whatever gets the baby here alive and well and keeps the mother safe is what should be done, end of discussion.
06:36 PM on 05/07/2012
C-section will be more acceptable to feminists once midwives are routinely trained to do it.
HUFFPOST SUPER USER
blondecuban
01:56 AM on 05/08/2012
I'm a feminist and this is not true. Why cut up a woman rather than let her deliver the way nature intended? This is all about the almighty dollar (or whatever currency is used in Brazil) and the doctor's desire to have his practice inconvenience his life as little as possible. By the way, Feminist is not a dirty word.
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HUFFPOST SUPER USER
surfette72
Hang on tight Libs...we'll be back.
11:33 AM on 05/08/2012
You are right blondecuban, feminism is not a dirty word. However, the concept can be riddled with double standards can it not? For instance; I thought it was a woman's right to do with her own body as she wishes. If that's true, then that must include elective c-sections for childbirth. I realize if I am pro-life, then that creates a double standard for me as well, but I will gladly admit that.
12:38 PM on 05/08/2012
I think that in the article, she addressed that Dr's don't have group practices, and as such...just like in the old days here...it would not be possible to attend every "nature-driven" birth. While this is not an excuse for this practice, it is true and has probably fed into the general culture of c-section as expected.

In the old days here, a Dr went to the 1st pregnant woman who went into labor, and stayed there til she delivered...if another woman in his town went into labor, she was tended by others til the Dr could get to her.
05:49 PM on 05/07/2012
I watched The Business of Being Born as my homework preparing for the delivery of my first baby. I am from Brazil, but live in the US. I was lucky enough to find a doctor who stood by me while I labored for 32 hours after my water broke. Unfortunately, nature had other plans, and after 32 hours in labor, I delivered my healthy baby via cesarean section.
I translated your article into Brazilian Portuguese, and posted on my blog (with credits and link back to this article). Here is the link to it: http://comereducaramar.wordpress.com/2012/05/07/cesareasnobrasil/
Let me know if there is a problem.
11:19 AM on 05/09/2012
32 hours is a LONG TIME!!! If you try it again, find some really great classes and preparation and support. It helps a ton, and it helps to be surrounded by people really proficient at natural birth (it's natural, but it's not OBVIOUS), and most of all, do what feels RIGHT. Trust your instincts, and when your body says it's not working, get whatever help you need so you can have a healthy baby and move on.
12:34 PM on 05/20/2012
I did all this. I had classes, I had support, I had a great doctor who stood by my side the entire time and tried everything possible so I could have my natural birth - that is why I labored for 32 hours. It just didn't work out, and nature had other plans for us.
techjockey
Keeping My Gratitude Higher Than My Expectations..
05:38 PM on 05/07/2012
Which childbirth method to use when giving birth is the mother's decision, alone.
Vaginal births cause tremendous pain & complications. My little sister was ripped from birth canal to colon when she had her first child & was on the operating table for 3 hours after giving birth.
If you are going to an obgyn that does not want you to deliver vaginally, seek out another one.
Sheeh!
12:39 PM on 05/08/2012
Maybe read the whole article before commenting, just a thought.
techjockey
Keeping My Gratitude Higher Than My Expectations..
10:10 PM on 05/10/2012
Did read the article, guess you are one of those that snarks those that disagree with your worldview.
05:19 PM on 05/07/2012
I am an American, and my first child was born in 2008 via a normal delivery in the US. Since 2009 I have lived in Brazil and gave birth to my daughter here last year. Everything said in this article is true. I was sure that, if I didn't fight to have a regular delivery, I would somehow be forced to have a c section. Many doctors recommended a c section to me, and I have met very few people from my peer group who have had a "parto normal", let alone a natural birth. Brazil is not as male dominated as you would think, but there is a pervasive desire to be more sophisticated and modern, especially among the emerging middle class. For many people, midwives and natural birth were part of life on the roça, or in the countryside, sometimes only a generation ago. Having surgery and apparent control over the birth process are more about eonomic and social status, in my view, and less about beauty.

There is a group of doctors and birth professionals working out of Belo Horizonte called Nucleo Bem Nascer, who are making a difference here. I chose them as my doctors even though it meant a heftier price tag, beyond my insurance. It was worth it. My birth experience was very good, although the hospital left something to be desired! Check out their website: http://www.nucleobemnascer.com.br/
04:10 PM on 05/07/2012
Why is that any of your business how a woman wants to give birth? It's her body and her baby.If you are so incline to have normal child birth feels free to do so when you give birth to your child. As for men, you can start complaining when you can get pregnant and have a baby.
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HUFFPOST SUPER USER
RaceCondition
Nerd. Liberal. Girl.
08:10 PM on 05/07/2012
Major surgery and weeks of recovery is no big deal to you? And you're a woman?
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HUFFPOST SUPER USER
SusanElizabeth1949
My micro-bio may be empty but my head isn't.
08:46 PM on 05/07/2012
What she is saying is that it is no one's business but that of the woman involved, not her's not Ricki Lake's nor yours nor mine. And I tend to agree with her.
02:23 PM on 05/08/2012
Let's see. If they want to have cesarean to have a baby who are you to tell them they can't? I won't and can't stop you if you want to give birth on the road either.
12:40 PM on 05/08/2012
Maybe...read the article before engaging keyboard?
02:17 PM on 05/08/2012
I did. But did you?
04:00 PM on 05/07/2012
There needs to be a midwife movement.
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HUFFPOST SUPER USER
arimoore
let's be nice
06:08 PM on 05/07/2012
There is! :)