O desencontro entre desejo e realidade: a "indústria" da cesariana entre mulheres de camadas médias no Rio de Janeiro, Brasil

Abstract

O artigo apresenta resultados de uma pesquisa qualitativa que buscou apreender e compreender, através da percepção e experiência de mulheres de camadas médias, o desencontro entre o desejo pelo parto vaginal e o desfecho em cesariana. Quinze usuárias de planos privados de saúde foram entrevistadas sobre suas experiências e percepções relativas ao pré-natal e parto. Os resultados evidenciaram uma (sutil ou explícita) interferência do obstetra sobre a escolha das mulheres, influenciando o desfecho em cesariana e sugerindo que, para muitas mulheres, não está sendo possível escapar das "armadilhas" de um modelo biomédico mercantilizado, interventor e iatrogênico, institucionalizado e legitimado pela sociedade. A pesquisa pretende contribuir para ações que estimulem o exercício da cidadania feminina nos processos decisórios que envolvem as questões da saúde reprodutiva, preservando e garantindo a experiência do parto como um direito inalienável das mulheres, seus companheiros e familiares.

A Decisão Pela via De Parto No Brasil: Temas E Tendências Na Produção Da Saúde Coletiva

“…The 28 publications [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40][41][42][43][44][45][46][47][48] having"decision", "choice", or "preference" for the route of delivery as central category were selected for analysis, as presented in Table 1, and used as written sources. Although one of the filtered studies was not an article, but an editorial, 34 it was included in the analysis, since it belongs to important authors in this field who have other publications on the subject being analyzed in the present review.…”

“…32,36,[38][39][40] Thedivergence of cesarean delivery rates in the country with those considered acceptable by the WHO, which recommend from 10% to 15% surgeries in the total number of births, are frequently addressed. [21][22][25][26]33,36,[39][40] The generalization of surgery is seen as a sanitary issue for presenting higher morbidity and mortality risks for the mother and newborn, as well as foraffectingbreastfeeding. 20,[32][33]36,[38][39] In defense of a more rational use of cesarean sections, "scientific evidences" are emphasized: good medical practices must be based on specific parameters, balancing benefits and risks and trying to avoid iatrogenies 20,28-29,32,40 the economic impact of the rise of caesarian deliveries on the health system must be considered, since indiscriminate use of surgery increasesexpenses.…”

“…29 It is advocated that, in the private sector, the "option" of women for cesarean delivery is a consequence of a type of dialog with the doctor in which there is little motivation towards the vaginal delivery and "guidance" (explicit or not) towards the cesareandelivery. 21,25,[27][28] In a study carried out in the Brazilian Unified Health System (SUS), the authors also concluded that the high rates of cesarean deliveries mainly reflect convenience and lack of training of professionals who, to justify their practice, affirm that women prefer surgery. 31 A study carried out in a teaching hospital with medical students showed how university education and medical residence focus on training caesarian delivery and inculcating the idea of practicality, convenience and safety of the procedure.…”

“…Sixteen articles worked with the idea, or found it in their results, that most women initially prefer the vaginalbirth. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Observing that a great number of these pregnancies ended in caesarian deliveries, many authors discuss women's autonomy in decision making around birth and the asymmetries of power and knowledge of physicians. Many authors notice that, along the pregnancy, physicians create a scenario of supposed rather than real risks which justifies intervention during prenatal care visits: "big baby", "narrow hip", "nuchal cord", are said to women, who "choose" cesarean delivery in face of the fear of being held responsible for any negative outcome, and their decision is jeopardized as a result of the "power of persuasion" of physicians.…”

“…[17][18][19] Another set of studies, discuss more sociological and anthropological concerns, such as the "decision", "choice", "preference" or "opinion" of women and professionals regarding the route of delivery. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Most studies point to the preference of women for the vaginal delivery in the initial phases of pregnancy, which contrasts with the growing number of cesarean deliveries in Brazil. In contrast, studies with professionals reveal their belief in the female preference for cesarean delivery and in the safety of the surgery.…”