The first study shows that many poor women in Brazil actively seek a caesarean section because of fear of substandard labour care, including lack of pain control.
Rich women were more likely to have caesarean sections, and a vaginal birth was considered a risky and negative experience. Many lower to middle class women sought caesarean sections to avoid what they considered poorer quality labour care.
The unequal distribution of medical technology has altered concepts of good and normal birthing, say the authors. Arguments supporting interventionist birthing “for all” on the basis of equal access to health care must be reviewed, they conclude.
The second study found that nine in every 10 women who gave birth spontaneously in hospitals in Latin America between 1995 and 1998 had an episiotomy, despite evidence that the procedure is not justified.
This situation is inadmissible in the light of the current evidence, and the challenge now is to change the use of episiotomy in Latin American hospitals, say the authors.
Making substantial progress towards improving the quality of maternal health care is urgent, writes Ana Langer, in an accompanying editorial. While we continue to discuss unnecessary surgical interventions, millions of women that require these procedures do not have access to them and risk their own and their children’s lives.