"I wanted a Baby, not a Birth." : birthing practices among poor and wealthy in a northeastern Brazilian city

Abstract

This thesis concerns birthing practices in Brazil. The context for the thesis is Salvador, the capitol of the sate of Bahia. In Salvador most births occur in a hospital. There are two separate settings for this: the private maternity hospital and the public maternity hospital. One major difference between the two is the rate of cesareans. In the private hospitals this rate is 98% whereas in the public hospitals this rate is an average of 25%. I have explored some reasons for this difference. My informants include women from upper and lower social classes. My main focal group was a yoga group for pregnant women. The participants all belonged to the higher social classes and would as such be expected to concede to a planned cesarean birth. Instead, the participants of this group took steps to prepare for a vaginal birth. Initially these women showed a uniform attitude toward pregnancy and birth. However, as the time for giving birth approached the women diverged in their attitudes. Some accepted the doctor's proposition to have a scheduled cesarean. Others continued to plan for a vaginal birth. Of the latter women, only a few did in fact have vaginal births. The ones who, despite extensive planning and preparations, ended up with a cesarean birth reported feelings of disappointment. They felt somewhat deceived by the hospital and the personnel attending to them. A common denominator among the disappointed women was a perceived lack of support after being admitted to the hospital. Furthermore, they also reported a lingering sense of doubt as to the actual necessity of the surgery. Could it be that the cultural norm of cesarean prevailed over the more alternative and culturally non-accepted vaginal birth? Exploring these women's reports of feeling disappointed by the birthing experience I found that disappointment is a trait they have in common with women of the lower classes who give birth in public maternity hospitals. Furthermore, these reports point to possible explanations for the high rate of cesareans in private maternity hospitals. My findings may also contribute to an increased understanding of the separation of birthing practices into two distinct systems, the private and the public, and how women giving birth within the respective traditions experience the practices. This in turn may shed light on the position of women and the existing class differences within the Brazilian society of today.