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Brazil ImageBrazil has a cesarean rate that is, depending on the year, the highest in the world. Their rivals include Taiwan and China, but not the United States. Here we hover around the 33% mark, but in Brazil about half of all babies are born by surgery and in some urban, private hospitals the rates are in 70-90% range.

To put this in perspective, if we took a 20% cesarean rate as “normal” (and I do not think that is normal!) as a 2010 World Health Organization report did, several million Brazilian women are having unnecessary cesareans every year. That report calculated a world-wide excess of 6.2 million cesareans annually and half of those are in China and Brazil.

(http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf, p. 8).

Why is the cesarean rate in Brazil so high?

If you ask Americans, they tend to blame Brazilian women.  Almost invariably, the first ideas we Americans have are about how the WOMEN must want more cesareans, how the women must be more used to surgeries (since they have so many more plastic surgeries than American women), how the women must be more concerned with keeping their vaginas tight and beautiful, how the women must not be willing to undergo labor.

But when I ask Brazilians in the United States, they tell me the same things that American women tell me. They say things like, “My doctor told me I didn’t have enough amniotic fluid” or “My baby was too big to be born vaginally” or “My baby was in distress.” In other words, Brazilian women understand their own cesareans as medically-necessary, even though statistically it can’t be true for most of them. (The same phenomenon occurs in the United States, I find.)

A 2014 article in the Atlantic confirms this. That article concluded that the medical system is not set up to support laboring women who are aiming for vaginal births (much less unmedicated vaginal births!). In hospitals where 70% or more of births are by cesarean, women who aim for vaginal birth are nuisances to the schedules of doctors and nurses. And it is a self-fulfilling prophecy that doctors and nurses who are skilled at cesarean birth become less and less skilled at managing natural labors.

All of this adds up to a fascinating cultural picture that I am eager to learn more about. So I am headed to Brazil at the end of May for a two-week crash course in all things birth in Brazil. I will be in Florianapolis with Ana Paula Markel, doula trainer extraordinaire, and in Belo Horizonte with my Portuguese teacher, who has promised to introduce me to young women and their families who are in the thick of this childbearing conundrum.

I’m so excited! If you are Brazilian, Brazilian-American, or an American who has given birth in Brazil, I want your stories!

Here are two articles if you’re interested in more.

http://www.theatlantic.com/health/archive/2014/04/why-most-brazilian-women-get-c-sections/360589/

http://www.pri.org/stories/2014-05-14/brazil-half-all-mothers-have-c-sections-whether-they-want-it-or-not

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Russia Breastfeeding article

This looks like strikethrough text, but click on it! It is the link to my article about breastfeeding and “low milk supply” in Russia. We are so used to our own cultural context that we can forget that we ALL see pregnancy, birth, breastfeeding, and parenting through our own particular culture. As a breastfeeding conference is underway in my favorite city (Toronto!), I thought I would share this article I wrote a while ago about my experiences in Russia.

Things have changed in Russia since I did fieldwork there in 2000-2001, but I still think it is valuable to understand how others in the world think (or thought) about women’s reproductive bodies.
You can also get to this article by clicking on the words ‘Related articles” below. That brings up the Google link!
by C Gabriel – ‎2003 – ‎Cited by 2 – ‎Related articles

THE EFFECTS OF PERCEIVING “WEAK HEALTH” IN RUSSIA: THE CASE OF.BREASTFEEDINGCynthia Gabriel. The state of Russian health has declined.

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I just read a blog by a woman who was trying to decide whether to hire a doula in her second pregnancy. She eloquently captures that inner dialogue that I bet a lot of women have about this question: Is a doula a luxury or a necessity? In her blog post, she talks about her unease with consumerism. Do we need to buy things to be happy? Do we need to spend money to regain our confidence in our own birthing bodies? You can check out her blog here: http://mothershavefeelingstoo.wordpress.com/2012/08/29/doulas-necessities-or-luxuries/

In this post, I want to offer one idea in response to the Mastercard-buy-more-to-be-happy-consumerist problem we all live with in the First World. One of the problems with consumerist culture is that we mistakenly believe that the THINGS we buy are what gives us pleasure. In fact, the things we buy are things that real humans made, transported, sold. It is their WORK that gives us pleasure. When we buy services (massage, health care appointments, a haircut, or doula services) this is more evident than when we buy objects.

When we remember that it is human’s work that we are paying for, not just “things,” we can make wholly different choices about spending money. We can spend money and stop being a “consumer” if that makes sense. We can USE money to connect with other humans. So often we do the opposite. We use the fact that we are paying someone money for something like a haircut or cleaning our house or taking care of our children as an excuse to treat them differently than we would a friend or relative. We all do it. (Be warned: Sometimes when I try to treat someone I am paying for a service more humanely than they expect, they act as if I am crazy.)

As a doula and as a woman, I value so-called women’s work — no matter who does it, men or women. Long ago as a teenager learning about women’s work in history I vowed that I would pay childcare workers fairly even if they themselves did not charge a fair amount (which is true in our area. Our babysitter charges an absurdly low hourly rate and doesn’t charge for sick days: hers or ours!). A more accurate term I learned in graduate school is “reproductive work” — which is all the work that is (usually) unpaid if it happens within a family. It is the work that is necessary to reproduce ourselves everyday (taking a shower, mending clothes, cooking, doing dishes, gardening, etc.) and to reproduce another generation (childcare, etc.)

Because of larger cultural and global forces outside of any one person’s control, we are not able to do all the reproductive work inside families anymore. In my case, a big factor is that my parents, my husband’s parents, and all our siblings (eight in all) live far, far away from us. The closest is a ten-hour drive; many of them live across the globe. Many of my friends rely on their extended family for SOOO much help. My best friend here sends her two kids to her in-laws overnight every Saturday. [An aside: I can’t imagine having a night off of children to spend with my husband free of charge every week. When we do hire a babysitter, we have to go out of the house. I would love to stay at home and sleep at home with my husband with no kids in the house!] Just because I would prefer to have much of this reproductive work done inside my family networks doesn’t mean that is the best way to do it in 2012.

In general, I try hard to be thoughtful about using money and when I pay for reproductive tasks I find I am even more thoughtful than when I am buying plain-old commodities like new running shoes. I want to be thoughtful when I am buying running shoes, too, but I find it is easier to be thoughtful when I actually meet and interact with the human who is doing the work. Because when I pay for reproductive work (cooking, cleaning, childcare, doula work) I am asking someone to step into the shoes of my relatives. I am asking someone to care for me/my loved ones. Money is just the vehicle that allows someone else to have the time to do this work that I do wish my sister, my mother, my grandmother could do for me. But they can’t. So I am using money as a tool — not a substitute — for connecting to real humans.

It’s not a perfect solution to our consumerist culture. But being clear that money is really a metaphor for human time and that what we buy is human work — not “things” — makes me more thoughtful about my choices. And the surprising conclusion I come to when I think this way is that I want to spend MORE of my money on things like doula services and home-cooked meals and less of my money on things like technological gadgets.

What about you?

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A Very Interesting Article.

I ran across this the other day and shook my head. As an anthropologist, I have to answer back! You see, anthropologists (including archaeologists) are humans who are shaped by the culture in which they grow up. So from about 1880-1960, archaeologists and cultural anthropologists from the United States and western Europe happened to notice aspects of so-called “primitive” cultures that confirmed their belief that there has always been a clear and firm gender division of labor. They gathered all kinds of evidence that men “hunt” and do “public” work while women “gather” and do “family” work. (Later anthropologists found that this clear, easy divide was often made up by the anthropologists who somehow failed to see things like men doing lots and lots of gathering because hunts were so few and far between. And, my favorite, is a recent article by an archaeologist who examines body weight and determined that men (fathers and brothers) must have done most of the carrying of toddlers and small children on frequent, long walks.)

These happen to be the same years that homebirth midwives were being pushed out of their profession by medical doctors. Birth was moving more and more into hospitals until, after WWII, there were more hospital births than homebirths in the United States. (The UK and Canada had a slightly different, but similar, history.) Women were increasingly drugged during labor and the rates of cesarean section climbed through the 1900s (and SOARED at the end of the century). Birth was increasingly seen as “dangerous” and “risky.” Hiring medical specialists to intervene in the process was a sign of prosperity and progress.

So it is no wonder that archaeologists (mostly men!) of the time interpreted the fossil record in light of this insight that birth is “risky” for human women. Indeed, human pelves are significantly different in shape from those of our nearest relatives (other apes). This “story” about the trade-off between bipedalism (walking upright on two feet, which ultimately changes the shape of pelvic bones) and giving birth to our young has been the dominant story for a long time.

Luckily, some anthropologists who grew up with feminism have taken a second look at that fossil record.  I love reading the work of Dana Walrath, an anthropologist who studies the evolution of human pelves (the plural of pelvis — cool, eh?). She believes that it has been pure sexism in archaeology and medicine that created this “birth is dangerous because of bipedalism” story (though understandable, given our cultural history). The feminist story is that we human women are amazing creatures who are incredibly highly-evolved to give birth to our babies. She’s got the bones to prove it! Check out her articles such as
1. Walrath D. (2006) Gender, Genes, and the Evolution of Human Birth, in Feminist Anthropology: Past, Present, and Future. PL Geller and MK Stockett (eds.), Philadelphia: University of Pennsylvania Press.
2. Walrath D. (2003) Re-thinking pelvic typologies and the human birth mechanism. Current Anthropology 44(1):5-31.

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It always feels so awesome to feel like you’ve made a difference in someone’s life. I met Heather Boyd last year as a student in one of my classes at Eastern Michigan University. I always offer “alternative” projects in my classes and in my medical anthropology class that fall I said that students could take a training program in becoming a doula, homeopath, herbalist, etc in lieu of a final paper. Heather took me up on the idea and became a doula that semester. She told her classmates all about the first birth she attended. I think they were all a bit in awe that she was out there, supporting a family at a hospital birth, while they were researching things like ADHD treatment in on-line journals. Last semester, she and two other students helped collect over 200 letters to representatives in support of Michigan midwives. This year, Heather is creating a non-profit “Students For Midwifery” and writing a workbook for teens who are pregnant. Check out her project on RocketHub and consider donating what you can. Twenty-five dollars? Ten? Five? It all adds up to better birth. http://rkthb.co/4703

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