Outrage over a practice that is so endemic and so chronic over time is just a cultural clash here. Perhaps if you had researched more extensively you wouldn't be so alarmed as to sound an alarm.
Latin America especially Central America has been constantly involved in vesting god-like power over women's bodies at the time of birth and during pregnancy.
It's even worse than you write in this column.
5
Doctors are no different in this country. I was forcibly given an episiotomy over my written and shouted objections, and while he was doing it the doctor refused to speak to me at all, while explaining to my husband that he needn't worry because the doctor would stitch me up "nice and tight." Pig.
6
Re: "...And so they got a court order for a mandatory operation. Ms. de Goes was almost fully dilated and preparing to return to the hospital when nine police officers knocked on her door to take her away. In the hospital, she was anesthetized, and operated on without her consent. Women’s rights groups denounced the procedure as an assault on her autonomy and a violation of her right to make informed decisions about her baby’s health as well as her own..."
I'm glad America's 1St Homophobic_Couple, (V.P.) Mike, 'N, (Segregation_Academy_Wife...), Karen Pence probably don't, (...can't?), ), read the NYT's, because...this article would only serve to fuel their theocratic fantasies
2
Because women's bodies are considered public property. This is one of the last regions in the world where women are not allowed to have legal safe abortions, and even birth control is practiced in defiance of religious leaders, encouraging the spread of AIDS and unwanted children living in the streets. The Catholic Church should feel ashamed of its role in this--in a region where Catholic priests have long been known to have secret families with children, in violation of their own vows.
32
I guess that this article could be read to suggest that "Latin America" has a serious history of paternalism and is moving against that. The situation in the US was pretty dreadful forty years ago, excesses of surgery, women having little control of the situation, etc. Things are better now in some places (notably wealthier districts) and that may be due to less patriarchy in the society, an increase in female OB-gyns, and greater independence of females in all walks of life. Latin America and US still have a long way to go, but the me too movement has probably helped. Is the situation described in this article even worse in extremely patriarchical societies like Japan and the middle east? I cant imaging that things are great in Suadi Arabia.
13
This article really shocked me. I had a son in a hospital in Sao Paulo in 1984, the care I received was as good as anything I received in the US. Admittedly I gave birth in a private hospital and maybe that's a big difference. This is tragic, hopefully shining a light on this kind of abuse will be a start in turning things around. Women and children deserve better.
13
The plight of women worldwide is just beginning to be told. Most women still endure pervasive violations of their human rights on a daily basis. Misogyny is the number one human rights problem in the world. While there are countries where human rights violations are a constant reality for men and women, even in countries with superficially better human rights policies, women still suffer horribly, especially when it comes to reproductive rights.
We in the US have no excuse for not doing a better job of taking care of mothers and their infants. The profound sickness of the anti-abortion movement has shown its diseased underbelly as it expands its agenda of misogyny to take away general reproductive care in the name of "saving babies". Planned parenthood was one of the best things that even happened to women in the US. Every penny that is spent on taking care of mothers and babies will come back a hundred times over.
28
'“Na hora de fazer não chorou” (“You didn’t cry like that when making the baby”)'
The article as a whole is troubling and that line is particularly horrifying. Some of them probably did. You don't have to consent to sex to get pregnant from it.
29
I am a healthcare provider. To dispel any illusion that forced Caesareans and other obstetric violations do not happen in the US, check out Improvingbirth.org or its Facebook site. It is the largest maternal health consumer advocacy organization in the U.S.
1
It is not only Latin America. Here in Ghana it seems that every young woman I know has delivered via C section. I also know several young, unmarried women, in their 20s, who developed cystic ovaries. Their doctors told them to go home and get pregnant to cure it; otherwise the cystic ovary would be removed surgically; with only one ovary they might never be able to become pregnant. So that is what they did. Delivered by C section, too. The docs got their surgery fees, one way or the other.
I agree that the situation in Latin America is troubling. While the US is not perfect, I will say that I personally have experienced excellent maternal care. My firstborn was delivered by C-section due to transverse lie, which appears to have been caused by a uterine anomaly. My second child was born at 29-weeks due to a very, very rare complication that necessitated early delivery. He is now a thriving toddler.
At each step my doctors engaged me in the decision making process. In the second case, the cause of my extreme pain and fetal distress was not known before surgery (rupture was suspected) and the doctors were careful to let me know that they couldn't be absolutely certain what they would find. Personally I found it reassuring that they were willing to admit the limits of their knowledge. Recently, when I consulted my doctors on the advisability of a third pregnancy, I also received competent and compassionate care that emphasized my primary role as decision maker.
It can get better.
1
I'm retired 12 years from OB. There were a few issues back then which were inappropriate, such as refusing to let a husband/partner be present at a birth or videotaping, but overwhelmingly, a laboring woman's choices were respected. I see it as a favorable development that the vast majority of OB residents are women. This has evolved because they tend to work in groups, so as to have a personal life; something which really didn't exist back then. My only regret is that residents are not being taught forceps. Done properly, it very much reduces birth trauma. Problem is there is no one to teach it any more.
3
In this article, the disgusting words that the physicians are using to describe their mother patients is highly disturbing. I was blessed to have wonderful doctors, nurses, and a great hospital staff here in Washington D.C. Even with phenomenal care, recovery from childbirth and raising a newborn are challenging, so I cannot even imagine how hurt the women must feel from such awful mistreatment from doctors. A mother is a human being and therefore, deserves to be asked and spoken to in a way that is not condescending but rather with the highest respect. Decision-making should be something a mother gets to do in her birthing and postpartum experience. Thank you for writing this article. More maternal maltreatment and disrespect ought be exposed and corrected.
6
The Catholic Church and other patriarchal religions bear the responsibility for so much abuse against women. It's baked into their belief system in attitudes toward sex and women's position in society. More brave articles like this will foster frank discussions and focus more light on the systemic abuse of women perpetrated by patriarchal societies and their ancient attitudes toward regulating woman to subservient positions in the world.
4
I cannot speak highly enough about my two home births. Caring midwives, a relaxed atmosphere, and a loving home. Two safe and gentle births.
I would never--NEVER--put my normal pregnancy/normal labor/normal delivery in the hands of the profit-driven hospital system.
Ostensibly this is about Latin America, but too many mothers I know here in the United States entered the hospital in labor and left with scars that cannot be erased--by c-section, by episiotomy, and from the mental scarring that occurs when your voice is ignored during one of the most important moments in your life.
50
@Liz Lev I enjoyed my hospital births very much. It was great knowing that all the resources for my babies were steps away, if needed. It would have of course been most comfortable to have my sons in my own bed, but my birth experience wasn’t about me; it was about my children.
And, most pregnancies are “normal”, until they aren’t.
19
@Link Right, and this is why I used CNMWs for both of my births; they have the same training as midwives who would be working in the hospital system, they just chose to deliver babies at women's homes instead. There must be a reason why the U.S. rate of cesarian section has jumped from 5% of births in 1970 to 32% of births in 2015, and the answer is not "more danger."
And to your final statement, I stand by my original premise: there is a such thing as normal birth, it is the most common kind of birth, but unfortunately the hospital narrative seems to have frightened women out of it. The most common complications (bleeding after giving birth) are staved by what is carried in every certified nurse-midwife's bag (pitocin--the same shot that a woman bleeding in the hospital would receive). Transfer to the hospital is always on the table if need be.
My births were absolutely about my children: a safe and relaxing environment in which we welcomed them to our lives.
14
@Liz Lev I have high blood pressure and so I never had the option of having a home birth, as many women do not. It matters that hospital births are as humane, safe, and centered on mothers and babies as possible. I had two safe births and I'm glad I had them in a hospital, but we have a lot of room for improvement and we all need to be part of that work.
5
These stories are deeply troubling, and the situation becomes more troubling when you realize stories like these happen in the U.S. Although police don’t arrest women and force them to have c-sections, many obstetricians coerce women into having them, and the “husband stitch” has been documented in the U.S. as well. Obstetricians are surgeons, and they act that way in the field. We need to rely on midwives, like most of the world does. This will bring the cost of giving birth down, and dramatically decrease the amount of c-sections performed.
53
@Michael A. I had "a boyfriend stitch" performed on me in 2012 in California in a supposedly progressive, modern hospital. Recovery took years and the doctor could not have been more apathetic. Many great doctors in the world. Also lots of room for improvement.
6
Perhaps it is time for the wives of the relevant OB-Gyners, the target of this article, should become Latina
#Me too'ers/ #ME-doers.
"You violate my sister, you violate ME.No more!" A voice for volatile-vaginalizers, in an enabled toxic, unnecessary-pain-causing WE-THEY culture. In which OB, at times,=OUTrageous Behemoth!
Literature, form a THEN narrative, enables the transmuting of satiating-description into needed explanations. Bridging information and knowing into critical necessary understanding. Moving from semantic caveats into relevant caring actions and mutual-help, when and if needed. Each needed effort a personal "risk" to "Fail better." "#ME-doers" is for far more than just turning heads. Eyes. Pages. "Kindle-" carrying-culture. Book-clubbing. Etc. Aroused Volatile Vaginalizers can be an effective body to be reckoned with against the personally unaccountable OB violators!.
1
And never forget the Irish women, who today suffer chronic back pain, incontinence, and blighted sex lives due to being subjected to (without their consent) the barbaric medical procedure known as ”symphysiotomy,” -(look it up if you have a strong stomach) when giving birth. As late as 1987 many Irish doctors, encouraged by the Catholic Church, practiced this excruciating and totally discredited procedure, when a caesarian delivery would have been indicated, in the belief that a C-section might hinder a woman’s ability to have multiple future births.
After years of protests, the suffering of these women has finally been recognized and some are receiving compensation for their injuries.
When rank misogyny enters the delivery room, and is then exacerbated by patriarchal religious beliefs about a woman’s reproductive life, giving birth can truly become a nightmare for women all over the world.
72
@Susan Thank you for sharing. That's the first I've heard of it, and it is indeed horrifying. But I'm glad I know. Thank you.
7
@Susan, religion, the curse of civilization.
10
@Susan
Good lord. Those poor women. That's one of the most harrowing things I've ever read.
3
I appreciate and agree with this article as an obgyn resident. I have certainly met women who were sterilized without their consent. We also take care of many women from Latin America who had unnecessary cesarean sections performed in their home countries and were not informed of the reason or given a choice. Because their prior cesarean sections were so often not indicated many of them go on to have a successful trial of labor and vaginal birth under our care and also under the care of wonderful midwives who work with us. I have also seen Latin American women in horrible pain go without an epidural because their husband falsely believes it will harm the baby, despite appropriate counseling, and the woman will not go against his wishes. Until we truly value women as a full and autonomous people misogyny will continue to taint their care at a very vulnerable time.
154
Latin America goes from Mexico to Argentina, your reporting appears to heavily concentrated on Brazil. Please be more specific, when you talking about about hundreds of millions of people that are inhabitants of Latin America.
1
Just another symptom of the evil, insidious hatred of women that pervades any patriarchal society.
5
All this disrespect for womens bodies is directly connected to religion. Let the church recognize, that limiting the number of children needs to be a womans choice and the abuse will hopefully drop. In this case, it might have been an irrational and uneducated choice on the part of the mother to opt for natural childbirth. Her choice might have endangered two lives and caused the entire delivery to be more expensive and time consuming than normal.
As for not being allowed to eat or drink.....20 years ago in Pittsburgh, right here in the US, I too was given a scant piece of ice to suck during a normal delivery. Not that I noticed. Can't think of why anyone would fixate on food when in pain. Unless one is starved for days, surely a couple of hours is no big deal.
2
I can't speak for Latin America but in India it is similar. Women are pushed by ob-gyns to have unnecessary C-sections because they are more lucrative. In conservative India ob-gyns are almost all female. So it is woman on woman violence.
5
Sadly, the worst ob/gyn I ever had was female. I nearly died of hemorrhage because she took so long to get to hospital. A resident signed to do procedure to save my life when cranky doc with attitude showed up and started yelling at resident . When I later documented I wanted this horrible woman fired, her practice declared bankruptcy and later renamed itself. She had many lawsuits against her. Don’t automatically assume all females are good and all males are bad. My next pregnancy I went back to my old ob just before he retired and he was an angel who was training his replacements to respect women. There are good ones out there. As to Latin America, the situation seems so hateful.
4
The headline of this article offended me. Latin America uniquely claims to love its mothers? And only Latin Americ abuses them? This is not just a disingeneous assertion. There are LOTS of problems and issues with babies right here in the US (including sky-high infant mortality rates). After reading the article I feel it is informative and fine, but this kind of headline plants wrong ideas and superiority into people’s heads, as if many of the situations described don’t occur in the US. Makes me mad for everyone who is not aware! Grrr. And the U.S. doesn’t claim to love its mothers?? Hmmmm...
5
The responses stating that female ob/gyn’s will solve problems or prevent issues in care are completely silly.
6
The struggle against obstetric violence in Latin America began in the 1990s with activists’ efforts to disseminate evidence-based practices in maternal and newborn care.
http://www.translation.pk/latin-translation.html
1
Disgusting. When will the endemic, institutionalized violence against women stop? It is so wearying, so disrespectful.
3
Do we need to create some sort of colonial administration for Central and Latin America?
They are clearly too different for one-size-fits-all, and we already know socialism devastates the workers' families.
I'd hate to see the U.S. get into this but a huge share of them all love the idea of living here already, but you'd have to sell it to the America-haters here at home.
1
The title of your piece is terrible deceiving and a 101 example of a straw man.
While I agree with a lot of what you said in it, I don't think that you should make such a generalization
2
To be fair, and seeking as an anaesthesiologist who spends a lot of his time in the labour suite, 'allowing' a woman who has had 2 previous Caesarean sections to deliver a breech baby vaginally would be universally criticised as poor professional practice in the UK (and I expect, in the US as well as in most other countries). While maternal wishes do of course have an important input into decision making, most judges will consider risks to the unborn child paramount and this is what drives obstetric decisions that run counter to maternal wishes. Also, if obstetricians were to follow maternal wishes when these seem unwise, and the outcome is harmful to mother or child, the professionals may well face being struck off and/or sued. I genuinely cannot imagine any obstetrician I work with agreeing to the proposition to allow for a natural birth in this scenario, and to suggest that ensuring a surgical delivery constitutes an infringement of her maternal rights makes me think the author did not do her research homework TBH ...
5
@Kai Rabenstein, maternal "wishes" do not "have an important input into decision making." Women do not cease to be autonomous human beings with the right to make their own medical decisions just because they are pregnant or in labor. There are no "wishes," there are women making decisions about their own bodies, so there is either consent, or there is obstetric abuse/violence. And people wonder why on earth so many mothers leave their births with PTSD. The woman in the article did not consent to a c-section, she was violated, cut into, and operated on at the hands of abusive doctors who chose to ignore her right to make medical decisions for herself.
Your language is inappropriate and betrays a fundamental disregard for women's rights to determine their own medical care - you, as the medical provider, can give advice and counsel, but you do not get to decide what happens to a patient for them. Honestly! Replace "maternal wishes" with "cancer patient." Replace it with literally anything else and that language of "allowing" a patient to make decisions for themselves becomes absurd.
7
Important article,depicting the abuse of professionals by belittling women's independence and intelligence in making their own 'educated' decisions. I guess we still live in a 'macho'society where we men trample on women's right to decide for themselves what's best. Coercion ought to be condemned. Case in point here, just because a woman had a previous C-Section, does not mean she'll need one the next time. And a real Obstetrician knows that. As they say, ignorance is arrogant.
4
This is simply horrifying - the rotten fruit of patriarchal attitudes. No government should have control over women’s bodies like this. And that includes the US government and right wing efforts to rule women’s most private decisions.
3
Hey, my doc used that line ('You didn't holler like that when you were getting pregnant') during my labor in 2001--it must be an oldie. It's not just Latin America where docs think they, by rights, run the show. Also gave me an episiotomy I didn't want and probably a 'husband' stitch: to this day I remember I had a vaginal delivery every time I sit down in a chair. Thanks doc.
1
What suffering in the world is not due to the patriarchy? From the grotesque aberrations in the RCC to obstetric violence, next to our destruction of our own habitat, THIS is the second most urgent catastrophe faced by humans.
3
Obstetric violence also occurs here in the U.S., but as it's explained in this NYT article about episiotomies, in some regions and in some hospitals, some obstetricians are starting to change:
https://www.npr.org/sections/health-shots/2016/07/04/483945168/episiotomies-still-common-during-childbirth-despite-advice-to-do-fewer
2
If you can’t get into medical school in the US, you can almost always get into a little bit bad medical school in South America. There they teach you to be a little bit bad doctor of medicine. then you get to practice bad medicine without reprisals from regulation or medical malpractice lawsuits. Even better, you will be supported and backed up for your practicing bad medicine by other bad medicine practicing doctors who went the same bad medical schools. This trend even happens in the US.
1
@Milque Toast you are totally wrong about your assumptions. Like this author, you are generalizing, carelessly insulting doctors in a continent that is 10 larger than the US. You must do your research, and then criticize with more attention paid to the truth.
Address the problem at it's roots. First change the message that birth control is evil. Having fewer children will enable women to have more control over their bodies. Let religious organizations send out a message of equality amongst the sexes. Oh and convince the women that this is the right step. One feels that things change slowly or not in a large part due to the number of illiterate women who believe inferiority and abuse are their birthright. Take a look at our own home grown religious right.
4
But America is the place with the lousy healthcare. At least, that’s what we’re always told, right? I’d rather be nowhere else than America for a serious trauma or illness.
Latin America "Loves its Mothers"?? Very amusing. Just like they have the greatest respect for women in general. Keep that in mind America when you are told by our government that there is no need for a wall and that our American culture is no different from that of Latin American countries.
2
this is all true, the famous "you did not cry when opening your legs" is an all too common comment in every hospital in Latin America, I heard it said to other women while I was in labor, which only made me encourage an unexplainable pain and then be congratulated for "being good to birth babies" and after my secend chuld my obstetrician refused to cut my tubes because "I was too young" yes I was 21 but convinced I didn't want more, needless to say I'm almost 40 now with now 2 adult sons and didn't have more kids, and bow I live in a country where I can exercise mi right to choose over my body, a right I keep dreaming women in my country would have... a right I wish I could've had when I was 18 and pregnant...
2
In India also we can see the same practices, no vaginal delivery especially. costs to become a doctor and setting up a hospital are the main reasons for c section practices in our country. No proper public healthcare systems , no awareness about health policy and if you have awareness also the costs to buy a health policy is very high.
7
Latin America "has a long way to go," a friend said to me one day. We were talking generally about social and economic conditions there.
US leaders would do well to heed the need for Latin American reform and use their powers to help steer our neighbors to the south in a better direction, rather than hold committee hearings designed for virtue signaling, in which they accuse US agencies and agency heads of "neglect," "mistreatment," and "abuse" of migrants.
2
The author does not mention that socioeconomic and education factors play a role on this issue.
Sometimes it is not enough to pass a law, women must be informed and educated about their rights.
8
Ms Barbara is obviously not a Physician. If she was a Physician like me, she would know that after two C-sections, the risk of rupturing a scarred uterus (scarred after the two previous C sections) is very high if one wants to deliver a baby through the vaginal route. In this case, the breech made the situation even more perilous, particularly for the baby. The obstetricians did the right thing and probably saved this woman's life. Sometimes, medical care consists in protecting patients from the consequences of their ignorance (shared here by Ms Barbara). We have currently the same issue with vaccinations where parents are directly responsible of putting the life of their kids at risk by refusing to vaccinate them. But in this day and age, everybody is becoming an instant expert...
12
@Francois wilhelm. I agree with you. My second child was transverse breech, which was scary 37 years ago. The difference is though, I had a female doctor, whom I liked and respected. But, still, wishing won’t turn your baby around and won’t strengthen a scarred uterus. Doctors could have handled it better; don’t you think?
4
@Francois wilhelm does it not give you pause to think that the police removed someone from their home and forcefully perform surgery on them? This is a question of legality and autonomy that I am talking about.
6
@Francois wilhelm--Sending nine police officers to the woman's home is "doing the right thing"? Forcing a woman to be anesthetized and operated on without her consent is the right thing to do? Wow. I hope I never have the misfortune to be treated by a doctor that believes he has to "protect" me in this way. Instead, I suggest patients should be protected from the arrogance of doctors like you.
7
"We can only wonder why obstetric abuse is so ubiquitous in Latin America, a place where motherhood is often sanctified."
The obvious answer is that Latin America is Catholic. Motherhood is sanctified because the mother of Jesus, Mary, is sanctified. But women are not.
In Catholic and evangelical Christian countries, including the red states of America, where reproductive rights including abortion are not decisions for women to make, why would anyone expect women's choices in childbirth and labor to be acknowledged or accepted?
Indeed, "obstetric violence" is a misnomer; what prevails in orthodox religious patriarchal sexist misogynistic societies is total disregard for women.
48
I lived in Central America for three years and saw first-hand the way women were treated as inferior to men in all aspects of society. There will be no change in obstetrics until the prevailing culture of machismo is changed.
32
In Chile, a law was passed just recently - August 2018 - against obstetric violence and protecting the rights of women giving birth. Sadly, in Peru, where doctors are known for forcing their patients to do c-sections because it is far more lucrative, this law does not exist yet. We have a long way to go in South America. Yet, the reason why people mistreat mothers while claiming to love them is because of women’s own misogyny, since after all, women raise most children in Latin America. Chauvanism is engrained in the education of children in far more subtle ways than access to education or certain occupations. Once we become aware of this and work for true solidarity among women will we see the effects of equality and respect in our Latin societies.
7
The high C-section and episiotomy rate in the US got a lot higher after fetal monitoring became commonplace in the 1970's. Before that if there was a bad outcome the doctor could state that he listened to the fetal heartbeat and the attorneys did not have a trace to show a jury. Afterwards the lawyers could say to the jury "look at that.....see where the heartrate dropped.....that is why this child has cerebral palsy or whatever......" After fetal monitoring came in there was no decrease in the incidence of cerebral palsy.....although few lawyers will ever admit it....just a massive increase in lawsuits and outlandish settlements and compensatory C sections. This is covered quite well in Peter Huber's Galileo's Revenge. So the US situation is much more nuanced and driven by the legal community. And I write this as a parent of a child with impairment.
18
This is a highly condemnable act. What’s wrong in discussing with the woman, who is going to deliver the baby and not the man that too when it pertains to her body ?
One thing I fail to understand is that whether such obstetric violence is still taking place in Brazil since the writer mentioned that certain laws were formulated protecting women from this kind of abuse in 2005 ?
5
@Sivaram Pochiraju
Yes!!
This violence against Brasileiras continues. With a new fascist president drastically reducing support for all social programs, we expect that the situation will only get worse.
Unfortunately, this continues a centuries old pattern of machismo imbued social policy that has treated women as possessions - or worse.
2
The experiences of these Latin American (new) mothers is fully relatable to Italian women's who in the last decade have been denouncing the same abuses by nurses and doctors during labor. Moreover, they used the same label to define these frequent episodes "obstetric violence" and they were accused of having misunderstood the situation and the coping strategy of the healthcare operators tackling difficult situations. Actually, I acknowledge this issue just when I watched some documentary with some victims telling their own stories of violence in the hospital. Honestly, I was merely aware of the abuses toward women who consent abortion by conscientious objectors in hospitals. Nevertheless, at least in Italy it's not a matter of female or male operators. Our nurses and women doctors deny the evidence of the phenomenon as firmly as their male colleagues.
13
The article would be better served if the author expanded on data (childbirth mortality, for example) across the region and not some examples that for all we know are anecdotal and specific to Brazil, given the broad generalization to the region.
5
@Carlos Broad generalizations or broad reality? Pick a Latin American country and simply spin the wheel and that misogyny will not only be prevalent but most often legally protected in some manner.
1
@Carlos
I completely agree. Latin American is a diverse continent with different countries, cultures and policies. I thought the article title should more closely pertain to Brazil instead of generalizing an entire continent. Important article though!
3
An important step toward improving the situation is to have a large number of female ob gyn practitioners.
34
@Suzy Not really. In India where I live almost 100% of ob-gyns are female. They put a lot of pressure on women to have unnecessary C-sections. Why? Profiteering. Greed is not gender specific. Here are some reference article.
https://duckduckgo.com/?q=unnecessary+C-sections+in+india&t=ffcm&atb=v114-2&ia=web
2
Def more extreme than in the USA, but in the USA women are subjected to Ceasarean and Episiotomy levels unheard of in Europe and much of the rest of the world. Part of the problem is that ObyGyn's have made a disease out of a natural process, and in the process have all too often lost the art of delivering babies. That too they are under the kind of pressure our litigious society puts on them, too, if they are seen as having made any possible mistake, and even if not.
But I have watched videos of experienced lay midwives delivering all kinds of babies with relative ease, and then i attended one of my patient's births, and this was at the ObyGyn labor ward of a famous respected local hospital. The labor nurse and ObyGyn were total strangers, emotionally cold, and my patient, who had no risk factors, was wired up to all kinds of equipment.
When we know how the nervous system works, and that natural birth involves a measure of relaxation and trust, how was this patient supposed to relax? After an evening of painful labor she was pressured into a cesarean. It was unclear as to the medical necessity.
22
I don’t trust doctors, period. Latin American or American. They are human beings and have all the frailties that come with it, including making mistakes and being corrupted by prestige and power. Yet, they hold themselves up as these medical miracle workers. Isn’t the first tenet of the doctors oath ‘do no harm?’ I’ve seen far too many doctors do just the opposite in the name of financial and/or professional gain. I’m 52 years old and never spent a night in a hospital as a patient because I don’t trust doctors, period.
15
Unfortunately social security either from government or not in some states of Mexico consent information to the woman doesn't exists. In my case, since the pregnancy, my husband was informed at first. His opinion discussed, prices, hospital type etc. I was almost ignored. At labour time I loose my name, always I was named "gorda", and episiotomy was stitched without anesthesy (It was in a goverment service finally). That occurred in a very religious region of the country. Paradoxically, in the government service in another state, where my second child was born the situation was very different, I acknowledge IMSS Mexico for excellent service.
29
As a Latin American son, father and grandfather, I'm glad to see this article. Too many wrongs have been hidden for too long in our societies. It's time for change.
99
I just want to give kudos to a great picture by Melinda Beck. I know the story is important and everything else, but wow that is a great piece of work. Thanks.
21
I live in Mexico and I can say that similar things happen here. The vast majority of mothers in their 30s-40s gave birth via c-section. Could say that number is at least 80% in my community.
With that said, it’s also important to acknowledge that women play a very important role in maintaining the culture, as the reality is that women raise most of the children in the country and have done so for generations. I don’t know enough to say that there is or is not a patriarchy as mentioned in the article, but I do know that there is a cultural cycle that involves women and that it can be broken.
19
I think obstetric violence is currently being carried out by any male or female ob-gym in the US who doesn’t try to fight for a new mother’s right to stay in the hospital for longer than a day or two. And of course, the insurance companies that set the rules are perpetrators of obstetric violence as well. And all pregnant women should have the opportunity to make their wishes about labor known in advance, on paper, like an advance directive, and these wishes should be followed except in case of an emergency. And until ACOG takes a long hard look at its continuing blessing of forceps use, I think that organization is perpetrating obstetric violence as well. But since violence against women is perpetrated in so many ways, is it even surprising that obstetric violence exists?
48
@Pala Chinta perhaps I’m an anomaly but I chose to leave the hospital as soon as possible after each of my sons was born. Both of my babies were home about 36 hrs after birth. I personally find it much easier and more restful to be at home with a newborn.
8
@Link Mothers should be allow the choice of staying or leaving. Not every new mother has help at home.
2
Extended hospital stays increase patient and infant exposure to multi-resistant strains of hospital superbugs, so the home is more often a safer place to be, provided that there exist reliable methods for continuity of care.
But, in response to the article, it is unfortunately, an unbalanced view of an otherwise very important and complex topic that deserves a humanist view from a more knowledgeable and responsible author than Ms. Barbara appears to be. A female professor of medical anthropology with children of her own would be an ideal starting point if the NY Times were interested in less sensationalist muck-raking and more responsible journalism.
An online search indicates that 82% of obgyn residents in the US are female. One suspects the figures for Brazil and other Latin American countries are much smaller, perhaps even with a reversed gender ratio.
The feminization of maternity care would probably be the most important step in remedying the horrendous situation of this column.
There is another problem, a more intractable one.
I'm not a physician, but I do have a PhD in economics from a pretty good school. I try to avoid the PhD environment, which holds itself a cut, or several, above the unwashed.
In my experience, M.D.s are, on average, the worst for expressing contempt for ordinary mortals, even worse than PhDs.
The article captures this contempt quite well. The doctor knows what should be done; the patient is a quack. Lie back and shut up.
Unfortunately, the belief in its sanctity and competence held by much of the medical profession is matched by the awe of doctors held by much of the population.
Until society stops deifying medical doctors, much of the problem of imperious contempt will remain.
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I was just going to make a similar comment. Most doctors believe that they have all the answers and when pressed on something. often react passive-aggressively. I would expect this effect to be even more heightened in cultures rife with machismo. That said, the U.S. has a well documented problem with the way it treats mothers during and immediately after childbirth. Our methods are far from perfect. I don't know if that is a function of the OBGYNs or hospital administrators or both.
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@alyosha In my many decades of adulthood, I've encountered a number of doctors like this. Early on, I expected that only male doctors would display that attitude. I was surprised the first time a woman physician brushed aside my concerns about something. I don't even remember what it was about but I've never forgotten my dismay and disappointment. I wanted to believe that all women doctors were better than that.
Regarding the issue of just plain disrespecting women, I required surgery to remove an ovary due to a cyst that might have been cancerous. When explaining his choice of surgical procedure, he referred to me as a "big girl." Yes, I was overweight. But I was fifty-one years old. In most circumstances, I would have flipped him off and gone to another doctor. But I was terrified of being told I had cancer and my primary care physician told me he was the best oncologist for reproductive organs, in the city. When he called to tell me the cyst was benign, he used the offensive term again. I wish that I had told him then that it was inappropriate and offensive but I just wanted to get off the phone with him. So, he's probably still calling adult women 'girls' in a medical environment.
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@alyosha There is an attitude problem, and a lot of troubling institutional issues, but there is also the fact that doctors witness many tragedies, and are sometimes more concerned to avoid one than worry about the patients issues with their tone.
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"In our conservative, patriarchal societies, a woman’s true vocation is to be a mother. We must sacrifice ourselves to fulfill our biological destinies. "
This isn't exactly unique to conservative, patriarchal societies. Even in our most liberal quarters, the assumption still is that every well-adjusted woman desires greatly to be a mother, and that a woman who doesn't want children has got something wrong with her (emotionally or psychologically) and is not a "whole woman." American feminism is still about "having/being it all" rather than about making choices, and having any choice be honored equally.
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I find that the liberal message does tell young women that motherhood is less than her career. This is done under a veil of “choice”. But this leaves many women wholly unprepared for the emotional reality of motherhood and leaving ones child in full time daycare to return to a career which supposedly gives women freedom and choices.
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Hmmm, this is not my 50 years of experience with hundreds of liberal or feminist friends and acquaintances over the years. It’s not even my experience with my Italian & Mexican Catholic parents & grandmothers (3 of the 4 of them were born in Mexico & Italy.)
I’m guessing this was written by a right- wing guy. Either that or Jen’s liberal feminist friends are jerks :D
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Oh, it’s not just Latin America that abuses pregnant women. The Christian pro-life movement seems use their mandate to block maternal care. It’s seems it’s okey if a women and child die from no access to prenatal and post natal care. Pregnant women are particularly vulnerable; it’s interesting who seems to spend a lot of time and money and energy on harassing and/or abusing them.
Strong healthy happy mothers make strong healthy children. Strong healthy happy children make strong healthy happy societies. When you become old and sick, you want strong healthy happy young people caring for you. The angry struggling young people tend to be neglecting, angry, resentful caregivers.
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The greatest enduring abuse is when people have children they cannot afford.
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... Or a top 1% who structure a political economy to deliver an underclass into abject unrelenting poverty.
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@Willt26 Indeed. Perhaps men should manage themselves, and/or - god I don't know - use a condom? But I somehow suspect you are not referring to both parties when you say "people".
Any woman still at home (home births excluded) fully dialated with a breach birth and two former C-sections should have her head examined. She is fortunate that everything worked out for her and baby.
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@JMM
As a doctor I agree that her decision seems like a very bad one, but she should be allowed to make it. Performing a surgery without her consent when she has the capacity to refuse is assault and should be treated as such.
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"We can only wonder why obstetric abuse is so ubiquitous in Latin America, a place where motherhood is often sanctified. "
It's no wonder.
When all is said and done women are everywhere treated as less than.
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Maybe it's time to stop having babies.... if this is the way women will be treated by the same kids once being born by them why for?????
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@Think bout it Lol ok, try suggesting it's time for men to have unprotected sex then and see how that goes.
Medical ethics education since 1990 has led to great progress in the US. But many other countries do not teach it at all, or claim it is too American and doesn't apply to their culture.
That's nonsense on stilts, intellectualized denial.
Actually some bioethicists have even suggested that Our Bodies, Ourselves should be counted as the first book in the field.
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Ditto for Colombia. The exceptionally high cesarean rate (upwards of 80%) in hospitals that serve the upper class coupled with very low cesarean rates in hospitals that serve the poor is another example of the failure of medicine in Latin America to practice evidence-based medicine.
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How sad that little has changed since I delivered by children in the early 70s. And I live in the United States. I wanted to try natural childbirth; one of my obstetrical team assured me that when delivery time came, he "knew best and would make the decisions." Fortunately, the other team member, while he had never delivered an unmedicated mother, was willing to support me. I did Lamaze classes, and while the delivery did not go as our classes had predicted, I had the tools to manage the situation, and delivered an amazing, spunky, healthy boy, with no drugs, and with discomfort but not "pain." I chose to do it again for the second child. Today, too many women are encouraged to choose C-sections so they don't disrupt their (and the doc's) schedules, or to have extravagant (and very expensive) anesthesia during childbirth. It is a joyous experience, and one modern medicine too often deprives parents of. Of course every delivery is different, and when there is danger to the baby or to the mother, trained doctors should make decisions based on the circumstances. But give mothers a chance, for goodness' sake.
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The last time I gave birth was 1981. I asked my male doctor not to give me an episiotomy unless it was absolutely necessary. I’m happy to say that he honored my request and I was up on my own two feet shortly after giving birth. I was fine leaving the hospital with my baby the next morning.
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@arjayeff I think some American obstetricians (and patients) prefer epidurals (I think this is what you meant by “extravagant anesthesia”) for two big reasons...... 1) in an emergency they can deliver the baby much faster due to the spinal already being in place. 2) in an emergency such as shoulder dystocia that can’t be resolved or the need for immediate manual placenta removal (this happened to me), the epidural saves the mother from truly horrendous and gruesome pain and the obstetrician from having to inflict it.
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