Adelir Carmen Lemos de Goés just wanted a natural birth.
Already a 29-year-old mother of two, she had a trained attendant assisting her; she had a healthy pregnancy. Adelir was perfectly willing to give birth in a hospital; she just prefered to avoid surgery.
But the hospital, like so many hospitals here in Brazil and elsewhere, thought otherwise: doctors insisted that Adelir's baby was in a breech position, and when Adelir sought to avoid caesarean by trying to sign herself out, in came the authorities.
A Brazilian court granted a prosecutor's request for the appointment of a special guardian. And just in case it was unclear whose life gets prioritized when a woman has a c-section against her will, the judge specified that when there is a "conflict of interests of the mother with the child's life ... the interests of the child predominate over hers."
Ten days ago, Adelir gave birth to a healthy baby girl, but she was treated like a criminal.
The cops don't always get called to the hospital, but forced or coerced c-sections are not unusual here in Brazil, where some hospitals deliver almost 100% of babies surgically. And as I've found in my visit across the country with the International Reporting Project, birth plans are as much about social class, religion and the role of women in society as they are about so-called choice.
"In our culture, childbirth is something that is primitive, ugly, nasty, inconvenient," Dr Simone Diniz, associate professor in the department of maternal and child health at the University of São Paulo, tells me. "It is something poor women are supposed to endure."
By contract, she said, c-sections are seen as "modern and elegant". In Brazil, low-income women largely depend on the public health system, which leads to much higher vaginal birth rates, while wealthier women use private facilities, making c-sections a kind of status symbol.
When pregnant women come to private hospitals here and indicate they want to give birth naturally, they're routinely told that there may not be a bed for them, since all the beds are reserved for scheduled deliveries. If a woman does go into labor and doesn't have a c-section scheduled, she can find herself boomeranging from hospital to hospital in search of an open bed. Some doctors request bribes if a woman wants to avoid a c-section, since they find unscheduled vaginal births inconvenient.
As a result, Brazil has one of the highest caesarean birth rates in the world. The World Health Organization recommends a c-section rate of no more than 15%. In private Brazilian hospitals, the percentage hovers between 80 and 90%. Nationwide, the c-section rate is upward of 50%. By contrast, about 30% of American women undergo caesarean births, and that rate is widely considered to be too high.
For some women, of course, c-sections are more convenient, while scheduling a birth offers a sense of control. But others are discouraged either by their doctors or by the reality of vaginal childbirth here in Brazil, which is often abusive and too often unnecessarily violent. According to Diniz, the chances of a woman going through vaginal birth and keeping her perineum intact are less than 5% – doctors routinely and often needlessly perform episiotomies, where the vaginal opening is cut during childbirth. Women also face verbal abuse from health care providers during childbirth, and the chances of a woman being abused increases dramatically if she chooses to go through labor.
"It's part of Catholic culture that this experience of childbirth should come with humiliation," Diniz says.
Abortion is also illegal in Brazil, yet more than 1m illicit procedures are performed every year. As recently as 2009, illegal abortion was the leading cause of maternal death here in Sao Paolo, the largest city in Latin America. And last week, a Brazilian research organization released the results of a survey indicating that large numbers of Brazilians think the way a woman dresses or acts may justify rape.
Forced and coerced c-sections, abusive birth practices, restrictive abortion laws and adherence to the she-was-asking-for-it rape myth – these malpractices all exist on the same continuum of belief: that women's bodies are public property. But when it comes to reproduction, those values also often prove illusive – women in America, too, have been forced into c-sections, and many of our reproductive choices remain overly politicized.
On Friday, advocates for reproductive freedom will rally at Brazilian embassies around the world. On Twitter, activists are organizing under the hashtag #SomosTodasAdelir – "We Are All Adelir". There's a conceit back home that America is the land of freedom and choice. But when it comes to reproduction, those values too often prove illusive. From Sao Paolo to San Antonio to Seattle, we are all closer to being Adelir than we think.
