While Argentine women may be famous for their willingness to go under the knife for aesthetic reasons, they are probably far more likely to be operated on during the process of childbirth.
The nation’s astronomical quantity of caesareans place it seventh globally in terms of the number of non medically justifiable procedures performed, after China, Brazil, the US, Mexico, Iran and Egypt.
According to those working in the field, Argentina’s private hospitals perform caesarean sections on between 50% and 90% of birthing mothers, while those of under resourced public hospitals are also around the 30% mark. World Health Organisation recommendations state that there is “no justification” for performing more than 10% to 15% caesarean sections on women giving birth.
In the 2010 WHO report investigating the number and costs of unnecessary caesarean sections globally, an estimated 139,178 operations were carried out in Argentina without need in 2008, at a cost of US$32m.
Its authors concluded that: “As with other procedures of some complexity, its use follows the health care inequity pattern of the world: underuse in low income settings, and adequate or even unnecessary use in middle and high income settings.”
Although figures in Argentina are high, excessive c-sectioning seems to have reached its pinnacle in neighbouring Brazil, and in China. These two countries combined account for around half of the world’s unnecessary c-sections.
The procedure increases the health risks for both mothers and babies compared with vaginal deliveries.
“Doctors have created this culture of terror, and by scaring women, they manage to maintain dominance. And a lot of women buy into this,” says Dr Carlos Burgo, obstetrician and author of ‘Parir con Pasión’ (Giving Birth with Passion).
Long a proponent of natural births, Dr Burgo has attended close to 500 home births in the past eight years and has been practising for close to 45, a period of time in which obstetrics has changed immensely.
“Medical interventions aren’t the problem,” Dr Burgo says. “The problem is that unfortunately there is brutal abuse of them. Almost all obstetricians now follow a medical conduction of birthing, which means they won’t even wait until labour begins naturally. Women are induced using drips, they end up with epidurals because of the pain or the unpreparedness of the cervix, and the woman is bed-ridden and connected to various tubes. In this situation women can’t give birth,” he argues.
Dr Burgo works with a team of midwives in the capital, who have a “fundamental” role in birthing, he says. Together, some members of the group are working to change legislation in Argentina to legitimise the status of home births, since neither pre-paid or unionised health care plans will cover the costs of midwives and obstetricians of women who choose to labour at home.
Midwife Sandra La Porta is the co-founder of Dando A Luz (Giving Birth), an Argentine organisation which promotes women’s rights during the birthing process and urges women to educate themselves against the “epidemic” of unnecessary caesareans, or “inne-cesareas” as they are known in Spanish.
“A caesarean section is not good or bad in itself,” La Porta says. “It’s an emergency procedure saving the mother or baby whose life is at risk or whose quality of life outside the womb is at risk. What is bad is a diagnostic criteria which allows for overuse.”
Childbirth activists globally claim that obstetricians perform caesareans to fill and empty hospital beds in a timely and profitable fashion, to finish shifts punctually, to avoid malpractice suits, and because they have not been trained in births following a natural, physiological, mammalian process.
Public health specialists argue that caesareans drive up the cost of births, and lead to inequality of health care access.
In Argentina 56% of births take place in public hospitals. A Ministry of Health report into the state of the Argentina’s maternity wards, cited by Clarín last April, found that just 44% had basic services.
Around 400 women in Argentina die giving birth each year, largely because of small maternity units which lack operating theatres, anaesthesiologists, blood banks, and professionals who might detect complications during pregnancy, experts say.
Larger hospitals are far more likely to have adequate staff and facilities, and in these, elevated caesarean section rates are a burden on a health system with an already limited budget.
A 1999 study into caesarean sections in Latin America published in the British Medical Journal noted that while higher caesarean section rates were related to higher income and social class, women with low incomes were those who had high obstetric risks.
The authors commented that: “No medical justification exists for the finding that women with low obstetric risk, and presumably least likely to benefit from a caesarean section, had higher caesarean section rates.”
A correlation was found between caesarean section rates and gross national product per capita, urbanisation and the number of doctors per 10,000 residents.
In Buenos Aires, and in other parts of the country, birthing at home is becoming an option for women who want partos humanizados, or humanised births. While accounting for less than 1% of births, women under the care of natural birth practitioners avoid the use of interventions and labour where they are most comfortable- in their own residences.
For photojournalist and restaurateur expat Sanra Ritten (29), the choice to give birth at home last year was immediate once she discovered she was pregnant.
“Close friends tended to be supportive, it was more people that I didn’t know that well that would be like ‘Oh my god, that’s crazy! Aren’t you scared something’s going to happen?’,” she says.
Ritten’s son Elías’ birth was not covered by health insurance, so she and her husband paid $4,500 for a midwife and her assistant, obstetrician and neonatologist to visit her son for three days consecutively after he was born.
“When you say homebirth, a lot of people, including my husband Diego, initially, immediately imagine there’s going to be some shaman here lighting incense or something, that it’s going to be really hippy, but my team was really professional,” Ritten recalls.
“My midwife brought with her tons of stuff, and we had a checklist of things we had to prepare, which included hiring a tank of oxygen. I definitely felt like I was in really good hands for the whole process.”
Ritten was fortunate that her recovery period was short, spent at home in bed breast feeding and eating gourmet meals prepared by her chef husband. Several of her friends had caesareans and experienced significant pain and discomfort post operation.
Researchers say reversing Argentina’s and Latin America’s caesarean section rates is going to take a concentrated effort from medical associations and schools, public health authorities, health professionals, and the media.
“The most wonderful thing we have been given is life,” La Porta says. “If you want to see how a society is going to look in a few years, you’ve got to look at the birthing process. We’re heading down the wrong path.”