When I was pregnant, I thought a lot about where I should give birth. I could remain where I was in Mexico or return home to my native country, Slovenia, where I’d have my family’s support, a gynecologist who had been seeing me for years and health insurance that would pay for all of my medical expenses. Despite all the apparent advantages of returning to Slovenia, I opted to remain where I was, in my new home. I remember thinking: The place doesn’t matter as long as my baby and I are healthy.
I was so wrong.
My belly began to look like it was going to explode and it was obvious that soon, my daughter would see the world for the first time. My pregnancy was going well, I hadn’t experienced any medical complications. I was dreaming of giving birth in the coziness of my home, where the only person who’d see me scream would be my partner and a midwife, a woman of indigenous origin, who was experienced in delivering babies by ancient methods, but also educated and certificated by official medical institutions. It all seemed like it could be perfect.
Until the question started to pop up like a bad joke: “Are you going to have a natural labor or Cesarean?”
At first, I didn’t understand how to answer. “Well, hopefully it won’t be necessary to cut me up,” I’d respond.
Then I realized that the way I would give birth wasn’t a question of medical necessity but rather a combination of a doctor’s greed, laziness, my personal choice and the amount of money I had. I realized that giving birth in Mexico wasn’t going to be the natural experience I had envisioned. In Mexico, labor was more like a cold and calculated event. There was a surgery room and the strange feeling of a pair of hands poking inside my abdomen.
It happened this way. Three weeks before my daughter’s expected date of birth, my gynecologist surprised me.
“Your daughter has to be born by C-section since her umbilical cord is wrapped around her neck,” he said.
I was disbelieving. Other women had told me about doctors miraculously discovering ways to take them to surgery.
“There’s no other choice, it’s wrapped around twice,” he told me.
Despite my fierce opposition, I was eventually convinced to go through with a C-section. But I still doubt whether it was truly necessary.
When medically justified, a Cesarean can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of Cesarean delivery for women or infants who do not require the procedure. On the contrary, C-sections can cause significant and sometimes permanent complications, disability or death, and therefore they should only be undertaken when medically necessary.
According to The American Pregnancy Association, the most common negative consequences of a C-section for mothers are infections, hemorrhage or increased blood loss, possible injury to organs such as the bowels or bladder, formation of scar tissue inside the pelvic region causing blockage and pain, extended recovery time which can have an impact on bonding time with the baby, a negative reaction to the anesthesia, possible hysterectomy, bladder repair or another Cesarean and higher maternal mortality.
In my own experience, I was overwhelmed by despair for weeks after I was discharged from the hospital. I was prohibited from taking a shower for 10 days. I wasn’t allowed to use the stairs, to eat heavy food, I couldn’t even lift my baby. I was ordered to stay in bed and rest, even though I had a newborn who needed to be fed, changed and handled constantly. Instead of enjoying this time with my daughter, I was suffering from the pain of my Cesarean.
And I don’t believe I was the only party at risk. C-sections can also implicate risks for a newborn. Research shows that babies delivered this way are often born prematurely and are more likely to have breathing and respiratory problems.
This could have happened to my daughter as well. My Cesarean was scheduled as soon as my pregnancy reached 38 weeks — I guess the doctor didn’t want to be surprised. But miscalculating a due date is common, often by more than two weeks, so it’s possible that my baby hadn’t completed even 37 weeks in the womb. By this age, birth is considered preterm.
According to the World Health Organization (WHO), the rate of Cesarean deliveries in any population should never exceed 15 percent, meanwhile, by the Mexican official standard, this rate shouldn’t be higher than 20 percent. However, data from a Mexican National Poll about health and nutrition show that the number of C-sections in the country between 2000 and 2012 increased by 50.3 percent — 46 percent of all births during that time were delivered by C-section. Today, investigators predict that Cesarean deliveries in Mexico will prevail over vaginal births by the end of this year.
After comparing WHO’s recommended rate and the current situation in Mexico, medical professionals have started to wonder why so many pregnancies end with a C-section. Are women here so different from others that the only way to safely deliver their babies is through a major surgery?
Investigators from the University Center for Health Sciences of University of Guadalajara and the Center for Demographic, Urban and Environmental Studies of College of Mexico — who analyzed thousands of birth certificates of babies born between 2008 and 2013 — have concluded that the obstetricians had justified their C-sections only by the three most common diagnoses, and that none of them had a solid basis.
Number one of these diagnoses is cephalopelvic disproportion, which is when the baby’s head or body is too large to fit through the mother’s pelvis. Nevertheless, according to the compiled data, the average weight of babies born by Cesarean does not differ significantly from the weight of the ones born vaginally.
The second most popular argument is a previous Cesarean. Although having a previous C-section can be a risk since the mother’s scar could tear during a vaginal labor — causing a hemorrhage that could put the mother and child in danger — the investigators emphasized that if the scar is at least one year healed, it’s sufficiently stronger and the risk of rupture is low. In this case, with more personalized attention, it’s not only possible but totally safe for a woman to have a baby vaginally.
The third most common diagnosis is fetal distress, which usually means that the baby is not receiving enough oxygen before or during the labor. Such newborns are examined right after the birth by special methods in order to determine the effects of the distress and its consequences. However, the analysis found that there wasn’t any evidence that fetal distress had actually happened during these investigated C-sections, and therefore the procedure was, again, unnecessary.
So why did the doctors diagnose these conditions? The authors point out two major factors when it comes to public hospitals. One of them is that hospitals have a limited capacity and a lack of medical personnel. There are simply too many patients, so in order to see them all and make room for the ones to come, doctors make short-cuts.
But for Elena Maria Garcia Alonzo, one of the investigators from the study, the most important reason is that many doctors lack professional ethics and feel superior to their patients, which often leads to humiliation, abuse and dehumanization. Some of the most extreme consequences of this kind of authoritarian mindset in gynecology and obstetrics are the colocation of intrauterine devices during labor, abusive sterilization and the increase of Cesarean deliveries. All of these practices are considered obstetric violence, which is a crime punishable by prison.
According to Garcia Alonzo, birth by an unnecessary Cesarean is obstetric violence because it implicates an intrusive medical practice that involves greater risk to a woman’s and baby’s life in comparison with vaginal labor.
Maybe I can understand (but not approve) why the lack of personnel and beds in public hospitals increase the number of Cesareans, but it’s totally beyond my comprehension why this would be happening in private hospitals as well, where the rate of C-sections is even higher — sometimes up to 70 percent of all births.
My own C-section was done in a private hospital because I didn’t have medical insurance. A part of me was thankful for the private room and the fact that my partner could stay with me the entire time. The predicted cost was acceptable — about $600 USD. However on the day of my discharge, that sum had risen to more than $1,200 USD because they apparently needed more medicine and material for my operation.
This is a good place to mention that C-sections cost a lot more than vaginal labors because they are major surgeries. They involve more doctors, more medicines, more care and a longer hospitalization — which all add up, resulting in a higher pay for the doctor and the hospital. Therefore, medical professionals might feel motivated to schedule a C-section, withholding the truth about the possible risks from the mother. And if a woman’s desire is to give birth vaginally, doctors have the ability to exaggerate in order to persuade her into having an unnecessary C-section — often during the last weeks of pregnancy or even in the early stages of labor when the mother is most vulnerable.
According to investigators’ conclusions, C-sections not only earn more money for the hospital and the doctor, they present an opportunity to practice a medical technique, or even just make it easier to organize time. This means that, in many occasions, the decision to deliver by C-section coheres to the doctor’s interests rather than those of the mother and baby.
It’s been nearly three years since the birth of my daughter — a dreadful experience that I had hoped would be magical — and I feel like I was a victim of a widespread corruption, along with many other women in Mexico. I still feel resentment toward my gynecologist, the hospital and the entire medical system. So because I am lucky enough to have a choice, my next baby will be born in Slovenia.