Do deceptive medical birth procedures de-humanize women?

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It was a rainy Wednesday late afternoon when pregnant Ana Cristina realized it was time to get ‘to know’ her unborn son João. She went to the Maternity Hospital Leonor Mendes de Barros in hopes of an easy delivery. Despite the pain and restlessness, Ana stood quietly for four hours waiting for care. “It’s a scandal that they treat you badly,” she said. After waiting so many hours ... Ana was informed that there were no vacancies and she should find another place to have her son.

... They would have make it across São Paulo city to go to another facility, the ... famous teaching hospital in Santa Casa renowned in Brazil for its quality of health care ...

... Many women face the happiness of their baby’s arrival with a fear of dying, along with the desire to care for their child and also to be cared for by their medical team. They have confidence in the hospital as the safest place to have a child. But they also carry the suspicion that their delivery can be abused by impunity and deceptive medical ethics by some medical teams.

Some women OB/GYN patients hear humiliating phrases from their medical providers during the process of childbirth, such as:

“Aren’t you too old to be having a baby?” “If you don’t shut your mouth…” “It didn’t hurt to make it, right?” “You didn’t close your legs then, now deal with it!”

Often women patients do their best not to complain and to follow the orders of the medical team ...

... André François, founder of ImageMagica, an organization that promotes education, culture and health through photography, has worked to document ‘humane medicine’ ... In the process he has also documented medical abuse ...

Can an unwanted caesarian be a form violence against women?

... vast differences in the health care system do exist. A universal healthcare system set to serve the poor in Brazil was widely established in 1988 offering free public healthcare for the first time to many in need. The system has suffered under many financial strains though with crumbling medical facilities and the theft of medical supplies in over crowed medical clinics that have had long lines with services that have turned critical needs patients away. But improvements in many levels of care have been made as some hospitals have been equipped with the newest medical equipment and trained medical staff.

François saw Brazil’s system of health care up close when he witnessed the case of one woman from the Amazon who urgently needed a caesarean section. But her journey to the doctor would not be an easy one. To get the medical attention she needed, she would have to face 12 hours of ... pain as she traveled by motor canoe to the nearest medical facility. In many regions of the country “when a woman needs a caesarean section, she will usually die,” says André.

In spite of attempts to offer free health care to many of the underprivileged, a 2010 Brazilian study, “Women and Gender in Brazilian public and private spaces,” ... 1 in 4 women in the country suffer today from some form of abuse during delivery.

But is there a difference between abuse and violence against women during delivery? What is the perception?

“Women with lower education, do not consider that the treatment they received was mistreatment and disrespect,” ... “Through accounts of friends and people of the same social group, they listen that the hospital delivery is like that: it will hurt, you will scream, they will scream at you,” ... “There is a perception of a picture that indeed is negative, but it is seen as normal. It is not even seen as mistreatment.”

In the public hospital in the town of Ceará in northeastern Brazil there is a sign on the wall alerting patients about their human rights. It tells them that they must demand decent public medical service. At the same hospital though, another sign outlines a very different picture. On another sign is a quote from Article 331 of Brazil’s Criminal Code, known as the ‘Desacato laws,’ that prevents freedom of speech for anyone who wants to speak out against injustice, including any patient who wants to talk about their medical care.

... Female patients who come from poor, rural and uneducated families often tend to be less acknowledged or counted as they become ‘objects’ in the hands of medical staff who can and do hold authority and power over them.

The World Health Organization recommends that the rate of cesarean section in a country should not exceed 15 percent. In Brazil the latest data for cesarean in most public hospitals is 35 percent. ... an alarming 80 percent of private hospital [use] cesarean section commonly. When women are asked if they want a cesarean delivery about 70 percent of women patients say no ...

Cesarean section, episiotomy, oxytocin and cosmetic vaginal surgery

... “most women go to birth without information.” Many are also convinced to accept cesarean section during labor while they are suffering from acute pain and unable to make the best decision. Women who are able to give birth ‘naturally’ are also most often submitted to episiotomy during childbirth ...

... 90 percent of hospital births throughout Latin America use surgical procedures for episiotomy without any medical need or indication. Without consultation with their patients numerous doctors cut and sew the vagina to shrink it after childbirth and to ‘satisfy the husbands.’ This operation is known in Brazil as the ‘husband’s point.’ ...

... The time a woman takes to complete labor in birth is another issue for medical teams who want to speed up the process. “There are reports that in some public hospitals, a woman should not be in labor from one shift to another, and all cases have to be ‘fully managed’ during the same shift,” ...

In addition to episiotomy, some women receive doses of oxytocin to enhance uterine contractions – and consequently the pain – so their delivery with childbirth is faster. But is it safe? Distinct dangers to the mother with incorrect use of the drug can cause fatal fetal hypoxia, a condition that denies a woman’s baby of life saving oxygen during the process of childbirth ...

Is there a solution to the problems?

Why do some medical teams mistreat patients in labor? Professional studies indicate that trivialization of social injustice, especially injustice against women, may be the cause. This can affect the entire society in Brazil, both male and female.

... Finding and supporting a good team of health professionals who will seek better quality health care for Brazil is the goal of photojournalist André François ...

Since 2000 the Brazilian program called ‘Working with Traditional Midwives’ ... has aimed to improve care for women with birth delivery at home. They also seek to raise awareness among health professionals to recognize midwives as important partners in the birth process for women.

As the definition of violence against women during childbirth can be wide and subject to many interpretations, so can the concept in the ‘humanization’ of childbirth. Numerous advocates who believe that babies who are born through a philosophy of ‘woman-centered childbirth’ are also beginning to see how natural and appropriate approaches to new technology with birthing can work together. The hope by many women’s advocates in Brazil is to see the rates of abuse during childbirth labor decrease sharply.

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