I was wondering what to write next on this blog, I had a couple of posts in mind before Christmas that I never got time to write, but they are hardly topical now. However, thanks to the NCT twitter feed I have something new to be cross about:
It's a startling figure, I knew the C section rate in the country was high but 52% of women choosing major surgery just because of worries about their sex life? That's pretty incredible, so I did a bit of digging and it turns out there were some recent news articles I missed about this. The main one (and do sit down for a minute as this may come as a shock) is from that great defender of truth, reason and equality - The Daily
I'm just going to call this as I see it right here; the Daily Mail piece is inaccurate, misleading, sensationalist, racist and deeply misogynistic.
First let's deal with the facts, or rather the torturing of them. The 52% figure is the overall C section rate in Brazil. Unless every single Caesarean performed there is due to fears about future sex lives then then the Daily Mail headline is clearly utter nonsense:
More than half of pregnant Brazilian women choose Caesareans over natural birth 'to protect their sex lives'
(Also, on a slightly pedantic note, 52% of births isn't the same as 52% of women, but anyway)
Even with this explained though, the 52% figure is still quite misleading as it hides a huge disparity in the mode of birth between those using the state system and the millions of women in Brazil who have private health care. In state funded hospitals about a decade ago the caesarean rate was comparable to the current UK rate of about 24%. But since then it his climbed and some figures put it as high as 40%. But even this seems low when compared to the staggering 84%* of births that happen by C section in private hospitals.
This disparity between public and private is important as it hints at another reason for the extreme number of surgical births in the country: Hospitals can make more money out of C sections. They require more people, more equipment and longer stays than a straight forward vaginal birth. They can also be scheduled to occur during office hours and the hands on bit for the doctors is usually pretty quick. No doubt this isn't the only reason behind the high levels of c sections but it makes rather more sense than most Brazilian women caring more about their sex lives than their babies birth!
*****Edited to add: for more on this see the comment below by Eloisa, who had first hand experience of this in Argentina which has a very similar health system*****
So where did that claim come from anyway? Was there a big national study of women's attitudes to birth which turned up the huge numbers basing major decisions on concerns about getting a bit, *ahem*, stretchy? Nope, as far as I can tell the whole thing comes from a comment made to a newspaper by one individual, Vera Fonesca, Director of the Brazilian Federation of Gynecological Associations who said that: 'The Brazilian woman is concerned with her sexuality and fears that giving birth will alter the perineum, which is a myth.'
Oh and since we are on the subject of myths, contrary to what the Mail article says: -
THERE IS NO WORLD HEALTH ORGANISATION RECOMMENDED CAESAREAN RATE!
There used to be one, until they admitted that some bloke just made it up and there was absolutely no evidence for it! - They dropped this rate in 2009! For how many more years am I going to have to say this?
Actually, no, lets not calm down, lets get onto the racism and sexism that weaves it's way all over this story.
First off, the Mail must have been so very pleased that this is happening in Brazil! Try to think of a stereotypical image of a Brazilian woman- most likely she is gorgeous. Tanned, toned, with enviable breasts covered in the tiniest of beach bikinis or sparkling samba costumes. She oozes sex appeal, she's a feisty, passionate lover. So of course all Brazilian women are like this, and it's not surprising that for more than half of them, the biggest concern of impending motherhood is getting back to all that wonderful sex, right? I wonder if the Mail would be so interested in the C section rate in Belgium?
Here's another question - Why is it inherently wrong for a mother to be concerned about her own sex life anyway?
Certainly if the sole reason for a huge number of c sections is false fears about future sexual enjoyment then that is a problem. But in that case caesareans aren't the cause of that problem, they are the symptom. The problem certainly won't be fixed by demonising those who choose surgery. Those fears aren't entirely false anyway. Vaginal birth usually causes no major, lasting, harm to the mother. But there may be reasons for some women worrying about how a vaginal birth might effect their future sex life. Many women suffer a torn perineum during birth and that could cause difficulties in the short term (although bravo if you feel like having sex at any point in that "short term" anyway). In rarer cases vaginal birth can lead to longer term harm and/or issues with incontinence, which could impact on a mothers sex life. These things are rare but they exist and it's perfectly reasonable to consider them.
Sometimes the damage isn't physical. Some woman experience considerable psychological trauma during birth and go on to develop PTSD. Where the traumatic birth involved a lot of internal examinations and interventions, especially if the woman feels she was forced into these and didn't truely give her consent, then future intimacy can become a huge trigger, sending the woman straight back to the stress and terror of the birth and leading her to avoid sex altogether.
On a related note, women who experienced sexual abuse earlier in their life may well want to avoid a vaginal birth and all that can go with that so as not to dredge up old traumas, something which could also effect their future sex life too.
All of those are reasonable excuses, but why do we even need excuses?
Let's think about a completely different decision, one that involves only men's bodies for a change. If a man is found to have early signs of prostate cancer he can have surgery or other treatment to reduce the risk of that cancer progressing. But the cancer may never progress anyway and the treatment can damage a mans sex life. So some men decide to avoid the surgery and accept the increased risk of cancer rather than the risk of those side effects. I'm yet to see a headline declaring that "Men Risk Cancer To Protect Their Sex Lives". Why should there be? It's a perfectly reasonable decision. Prostate cancer mostly occurs in older men, most of them will have children already but that doesn't mean they don't still want to have a sex life - so why doesn't the same apply to women? Our society has mostly moved on from the idea that young men should "spread their wild oats", while women save themselves for their wedding night, but mothers as sexual beings still doesn't seem to be something we are entirely comfy with. Mothers are supposed to exist in a constant state of grateful self sacrifice for their offspring. Still wanting to be able to have a decent shag with the kids Dad doesn't really fit in with that.
So does the Mail think that 52% of Brazilian women are so dim witted and sex obsessed, that they would still choose needless major surgery, even if they had accurate information about how unlikely it is that a vaginal birth would harm their sex life? Or are they just plain horrified at the thought of a woman, a mother, making that a consideration at all?
None of this means that I think a c section rate of 84% or even 52% or 40% is fine. Speaking as someone who has had two C section and a very long labour I know from bitter experience that the surgery is not an easy option! I really don't believe that huge numbers of Brazilian women would choose a C section without a good reason, if they were actually given decent information and not put under pressure by hospitals.
But (like the WHO) I don't think there should be any ideal caesarean rate. Contrary to what some of the news stories are saying, modern caesareans are very safe for both mother and baby. Especially when they aren't done in a rushed emergency. So if a woman looks at all the evidence and decides she wants one, even if her reasons seem frivolous to some people, you know what? Her body, her choice.
Mostly I'm annoyed with the Daily Wail, but the paper seems to actively troll it readers, so they are probably pleased about that. But what about the NCT tweet that got me into this rant in the first place? I really want to give them the benefit of the doubt, best case scenario it was a poor choice made by an individual manning the twitter account and in need of something topical. But the NCT has often been criticised (and not just by me) for being anti caesarean and propagating unevidenced nature-knows-best type beliefs. They always counter that they support all parents' choices and give only evidence based advise but if that is the case why promote a "news" story that is so very lacking in evidence and which is sexist, anti choice and sensationalist too? As I say I'm inclined to go with the best case scenario that it was just a silly mistake, but at worst it suggests that some of those old judgmental attitudes and beliefs still linger in the organisation. Come on NCT, you can do better than that.
*I've actually seen a variety of figures for both public and private in various newspapers but I'm going with the most commonly used, which is also the highest as I haven't been able to find a good original source - if anyone has one, please let me know!