“Although he insisted, I completely refused.
I had decided:
she was going to be a mother by cesarean section and not by natural birth
.”
Daniela Adamo reveals her convictions and explains to
Clarín
the reasons for a trend that, according to doctors, is growing:
cesarean sections on demand
.
Scheduled births at the mother's request, without any medical indication.
Daniela shared her story in a positive and clear tone: although it may seem strange to some,
a woman who refuses to have a vaginal birth is as much a mother as the others
.
Sofía Juliana, the baby that Daniela is expecting in a month (with a scheduled date), will know it well.
And Juan Martín already knows it, upa from Daniela.
In January it will be two years since the cesarean section through which she was born, at the request of her mother.
A survey this year of more than a thousand deliveries that occurred at the Military Hospital (whose sample excluded patients with two or more previous cesarean sections) reported that
12% had been cesarean sections by choice
.
There are doctors who raise that figure and suggest that it could be closer to 15%.
For now, the authors of the publication of the Argentine Federation of Gynecology and Obstetrics Societies (FASGO) affirm that of the 12% of those consulted who had chosen
cesarean section
on demand
, the majority (26.9%) opted for this intervention to , incidentally, perform a tubal ligation.
Daniela Adamo shared the story of her cesarean section on demand.
However, if the women who chose a cesarean section because “
not wanting to go through labor
” (25.2%) and those who did so because of “
fears
” (12.6%) are grouped together, it turns out that the majority group is 37.8
%
(of the original 12%) who
expressed some kind of fear of natural childbirth
.
Among the women who chose the cesarean section “
for comfort
” and those who did so to promote “
family organization
”, we can speak of a second large group (35.3%) of women inclined towards the idea of
cesarean section = comfort
.
Cesarean section on demand or natural birth
“There are no official measurements, but the figure that always circulates in conferences and halls is that in private hospitals, cesarean sections account for 80% of births,
almost double that in the public sector
,” reported Miguel Huespe, head of the Maternal Department. of the Santojanni Hospital, professor of Obstetrics and director of the Department of Tocogynecology of the Faculty of Medicine of the UBA.
Due to the questions and to demystify the historical rumor of a supposed economic return, the most reputable institutions have been trying, for years,
to reduce the number of annual cesarean sections
.
Given that the WHO recommends that cesarean sections do not exceed 15% of births, how is the increase in requests for cesarean sections without real medical indication interpreted, with the tremendous local figures?
The ground is bogged down and the obvious question is
how much obstetricians can influence these types of decisions
.
v1.7 0421
The trend of cesarean sections on demand
Although there is little statistical evidence, doctors from different fields observe an increasing trend to schedule births.
Figures in percentage.
Births by elective cesarean section
Source:
"Cesarean section on demand: A growing trend."
Carmelli MR et altri,
in Argentine Federation of Gynecology and Obstetrics Societies (FASGO), 2023.
Infographic:
Clarín
The doctors consulted for this note, Huespe and the Konex 2023 Prize in Public Health, Mario Sebastiani (adjunct professor of the Department of Tocogynecology of the University Institute of the School of Medicine of the Italian Hospital, an institution where he is also an obstetrician), recognized
an increase of cesarean sections requested by patients
.
They attributed the phenomenon to female empowerment, greater awareness of the right to decide about one's own body, and an organizational issue.
It should be noted that those who - on the contrary - promote that vaginal birth
is better
, are based on premises with proven scientific evidence.
Basically,
greater health guarantees and a speedy recovery for the mother-baby tandem
, given the various organic processes that are triggered by default in the labor itself.
Thus, an antinomy grows that for many will not be easily resolved: natural and healthy but socially imposed birth ("
the woman who does not go to a cesarean section is better or braver
," indicates the collective unconscious) versus the cesarean section, an artificial intervention. , invasive and apparently more risky, but, in this case, chosen.
Birth at the appointed time
“When we arrived at the appointment, about six months pregnant, we asked the doctor that we wanted a cesarean section.
He asked me why.
I explained to her that it was by choice and that I had totally decided,” Daniela recalled, and expanded: “My whole family had problems with natural childbirth, both with dilation and other issues.
I'm a very anxious person and I wanted to schedule it.
“I needed the doctor's support, something that is not always achieved
.”
She was asked about the risks of cesarean section compared to vaginal birth.
Daniela stood firm.
“Although there is more risk in a cesarean section and the recovery from natural birth is faster, I always felt very safe because the doctor gave me security.
I wanted to avoid contractions and water breakage at all costs
.
It was out of fear.
I needed to stay calm.”
For her, "there is
a taboo regarding what a cesarean section entails
, there is a lack of information. It would be ideal if the tendency to give both options arose."
The view of obstetricians
In the interviews, Huespe and Sebastiani started from the same place, but ended up divided.
They began by saying that requests for cesarean sections are growing and emphasized that today, compared to a few decades ago,
“cesarean section is a really very safe procedure
. ”
Daniela is a patient of Huespe.
Although the doctor did not deny her request for scheduled delivery, she assured that
she is far from encouraging this practice
.
He believes that cesarean sections on demand "in part rise due to empowerment and greater female awareness of the value of preserving the pelvic floor from gynecological-obstetric traumas, but they are also
a product of misinformation or lack of doctor's support
."
"Caesarean section
is not without risks
, if one compares the morbidity and mortality figures," emphasized the specialist.
And he pointed out two problems: prematurely scheduled cesarean sections (quite common, he said) and the risk of the newborn suffering from breathing difficulties.
Regarding the latter,
he shared a little-disseminated fact
: “In addition to the hormones that help the mother-child binomial in the entire postnatal adaptation process, passage through the birth canal generates compression and decompression in the baby's chest, a rhythm that "It helps you adapt when moving from the aquatic to the aerial environment."
Controversy over births
Sebastiani proposed
reviewing some concepts
.
One of them is highly controversial: "What has not been proven is that childbirth is better than a cesarean section. There is talk of greater morbidity and mortality because everything was mixed in the statistics, including emergency cesarean sections. These are not clean data."
He assured that "the work of comparing natural birth and elective cesarean section was never done.
The WHO always said that this work is unethical
, but most researchers would say that it is fundamental."
"What's the problem? If it were proven that scheduled cesarean section is safer than childbirth,
the world would not be able to afford the number of cesarean sections that women would want to have
," he launched.
Then, she stated her position: “Women were not offered this before and
today we have a society that reviews its values
.”
One of them is vaginal birth, which I would say has a relative value." Furthermore, she added, "who is more of a woman?"
The one who gave birth vaginally?
The one who breastfeeds for three months?
The one that gives it two years?”
Sebastiani highlighted the
benefits of avoiding improvisation
: “Scheduling for a woman is important, especially if she has children or if she has a partner who travels and wants her to be at the birth.
With cesarean section there are no risks, the problems of fetal distress due to aspiration of meconium fluid disappear.
The patient is fasting, everything is programmed, put together and is more neat.
Emergencies are avoided.”
“No, I am not a promoter.
We give them a choice,” she replied, when questioned by this medium.
But he continued: “Now, if you are going to have your baby at the end of December, I tell you: I don't think I'll end up having a birth on December 31st at night.
"The capable anesthetist is not there or there is a different staff."
“You have to understand that an important event is going to happen, the birth of a baby, and
you have to bring it to a maximum safety standard
.
The most dangerous moment for a child until the age of 18 is her birth.
“I am a promoter of not taking risks,” she noted.
There are many elements on the table, but new realities are emerging in the offices.
For Huespe, some are disturbing: "I recently had a patient with an important executive position. She requests a cesarean section, has the baby on a Friday and returns to the office on Monday. I notice a depersonalization, in some cases.
As if having a baby were a Procedure
".
ACE