Is birth the old-fashioned way on its way out in Mexico?
The sight of a pregnant woman in labor has become increasingly rare in Mexican hospitals, which now have the highest rate of Caesarean procedures in Latin America. Nearly one in two women give birth by C-section in Mexico today in public and private hospitals; in private hospitals alone, the rate is 70 percent.
Caesarean rates in Mexico far surpass World Health Organization (WHO) recommendations for a target rate between 10 and 15 percent and are beginning to draw scrutiny.
“It’s been high for awhile but it’s climbed to alarming levels,” says Glenda Furszyfer, a doula, or birth assistant, in Mexico City.
The factors driving the rising rates of C-sections are numerous, ranging from Mexican consumers’ increasing economic power to lopsided insurance payouts that favor surgery, as well as doctors and patients who prefer the convenience of scheduling birth.
There is also the example set by its northern neighbor: Caesarean rates hit their highest in theUnited States in 2009 at nearly 33 percent, according to the American College of Obstetricians and Gynecologists (ACOG). Despite ACOG’s recommendations that hospitals limit C-sections to cases where the health of the mother or baby is at risk in a vaginal birth, the rate hasn’t abated.
“It’s a reflection,” says Dr. Jorge Kunhardt, director of Medica Sur Lomas, an upscale private women’s hospital that encourages fewer C-sections. “Whatever happens in the US, we learn it here in Mexico.”
And yet Mexico has far surpassed US rates, prompting concerned health professionals and consumer advocates to question the risks to women and families of so few natural births.
The only choice?
When Mariana Granados told her Mexico City gynecologist that she and her partner were planning a pregnancy, she says the doctor spoke about Caesarean surgery as if it was the only option. It was a natural recommendation: The gynecologist herself had two C-sections, as had the other doctor with whom she shared a practice.
“I wanted something more natural,” Ms. Granados says, so she switched doctors and hired a doula, Ms. Furszyfer.
In Mexico and across Latin America, rising incomes have led more couples to choose private hospital care and more technology in birth, including C-sections. According to the WHO, a doubling of income corresponds to a 77 percent increase in the rate of Caesarean.
Although studies show Caesareans can present higher risks to the woman and baby compared with vaginal delivery, practitioners in Mexico say doctors rarely discuss these risks with patients. Longer hospital stays, exposure to infections after the operation, and greater complications in subsequent pregnancies are a few issues cited by ACOG. Infants born through C-section face an increased risk of respiratory problems and more often struggle to breastfeed.
Recent research has also linked Caesarean sections to higher rates of obesity in young children, one theory being that these children miss the crucial intestinal bacteria that must be acquired in the birth canal.
Still, the pressures to choose the relative knowns of surgery over the unknowns of natural labor continue to press doctors and patients toward the former.
“Caesarean section gives us much greater control,” says Dr. Francisco Padilla Del Toro, head of a public hospital in Mexico City’s San Angel neighborhood. “Yes, there are more risks in Caesareans, but the control over those risks is much greater.”
Then there are insurance concerns, for doctors and patients. Many private Mexican health plans pay for Caesareans but not for vaginal birth, even though at a private hospital the costs are similar, about $4,000 for vaginal delivery and $6,000 for a C-section. Doctors at private hospitals opt more quickly for C-sections if complications arise due to the threat of lawsuits – likewise one of the driving reasons for the high US Caesarean rate.
“There is no question that where there is an unfavorable climate for getting sued, physicians have [a] lower threshold for when they decide to perform a Caesarean,” says Dr. George Macones, chair of obstetrics and gynecology at Washington University in St. Louis.
Doctors feel the economic pressures day to day, as well, not just in malpractice.
“Financial incentives play an important role,” says Katia Garcia, a researcher with Mexico City-based consumer rights group El Poder del Consumidor, which works to educate women about their birth options. “Doctors that can program Caesareans all day earn a lot more.”
Against the grain
Granados gave birth to a boy, Luciano, nearly two months ago at Medica Sur Lomas, the hospital that encourages fewer C-sections (although the hospital’s rate is still well above the recommended average at 53 percent). He was born in water, without many of the typical hospital interventions and no pressure to have a Caesarean, she says.
“In Mexico at least, women opt for Caesarean with the idea they won’t suffer,” she says. “But you realize that [in vaginal birth] you recover much more quickly. It makes me sad that Caesareans are such a common, dominant practice.”
Her family and friends treat her experience like a rarity, she says. “No one can believe I had a natural birth.”