Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am from Brazil and the elective c-section rate at *private* hospitals is over 90%. It is assumed this is the route all middle-class women prefer. I had my first baby there and did just that. I was shocked when I had my 2nd baby here in the DC area and docs actually asked me if I had a birth plan.

I lived in Brazil and have a lot of Brazilian friends and always found this interesting. None of them-including several doctors- ever considered anything other than a section. They view vaginal birth as something to be avoided and for poor or very rural people. Something you would do if you couldn't afford a good hospital and were likely to have tons of kids, which is not generally desired by the middle class and up. Increased risk after multiple doesn't really phase them because none of them ever planned or wanted 5+ kids.

The maternal mortality rate in Brazil is appallingly high: 30/100,000 -- 30 women die out of every 100,000 giving birth (for comparison, in the U.S. it is 17. In the UK it is 6). With all those c-sections you would think they could save more moms. But the reality is performing too many c-sections increases deaths, just as does performing too few of them.

Would have to look at the data, but really not convinced wealthier women having c-sections with competent surgeons in private hospitals is driving this maternal mortality rate in any statistically relevant way. I'd expect the 14 year olds in the favelas and in rural communities are largely driving this, the 30-something bank execs in Sao Paulo and Rio? Not so much.

They are both driving it. There are numerous articles analyzing this if you google it. It's tempting to think this is another thing wealth protects from but the reality is the risks of surgery on wealthy people are still there, though many of the worst ones are downstream risks that only become life-threatening in a subsequent pregnancy or procedure. It also seems logical to think of surgery is a "controlled" and predictable event that correlates with safety, and they are very safe, especially the first one. But they also do have higher risks of severe complications than vaginal delivery typically does (while obviously vaginal delivery carries some risks of severe tears, although there isn't a good understanding of the risk factors for severe tears that would help people avoid them..)