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Wednesday
Jul212010

Mexico’s Fifty Percent Cesarean Rate

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This is a translation of an article written by Cinthya Sanchez that appeared in El Universal on July 18, 2010. The original article, En México, uno de cada dos niños hoy nace por cesarean, can be found on the El Universal site.

Aquí se puede hacer comentarios en español. Si usted es mexicana, por favor cuéntenos de la situación en su país.

  

In Mexico, one of every two children is born by cesarean section

The standards recommend not exceeding a maximum of 15% of vaginal births, the rate in this country is up to 70% in private hospitals and 40% in public hospitals.

For 30 years, cesarean birth is a business that has flourished in Mexico. In 1990, the country doubled the rate recommended by the World Health Organization (WHO) and, 20 years later, one out of two Mexican children is born by cesarean section despite the fact that the Mexican standard NOM-007-SSA2 1993 states that any obstetric care facility should have guidelines for the indication of cesarean section and their rate should not exceed 15% of total births in the second-tier hospitals and 20% in the third tier hospitals.

However, the latest figures (2007) show that the cesarean rate is 70% in private hospitals and 40% in public hospitals, making Mexico the country with third highest rate of cesarean sections in the world, after Italy and Chile.  Until now, hospitals have not been required to meet the standard, and the main reason is that cesarean section is a business.

Doctors spend five times less time for a cesarean section than with a laboring patient and charge an average of 25% more. Private hospitals charge 35 to 50% more if a baby is born by cesarean section compared with vaginal delivery.

A 2002 study based on public health data from 126 countries found that the estimated rate of cesarean sections in the world was 15%, while in Latin America and the Caribbean, the average rate was 29.2%: Mexico (39.1%), Brazil (36.7%), Dominican Republic (31.3%) and Chile (30.7%).

Eight years later, the numbers are on the rise and data from both the private and public sector shows that one in two children is born by cesarean section.

 

Most common reason for insurance claims

Insurers do not report losses for this trend, as the Mexican Association of Insurance Institutions (AMIS) reimburses a maximum amount for childbirth and cesarean section, regardless of how the birth occurred

There are 30 insurance companies that sell medical insurance to cover pregnancy and birth or cesarean delivery. In order to be covered by the policy, the policy must be at least two years.

“The price depends more on the health status and age of the insured, since the function of the policy is to compensate the medical expenses from accidents and illnesses covered by the policy, it does not question the medical treatment,” says the AMIS.

Yet, according to its own figures, in 2009 the cesarean section was the most frequent reason for an insurance claim, with 7% of the total and average amount of 22,562 claims filed.

But it isn’t insurers who are investing money— the most affected are the insured, facing all costs.

In March of this year, Profeco requested information on 47 private clinics and hospitals that offer maternity service packages for [vaginal] delivery, cesarean surgery and psychoprophylactic birth in several cities.

They found that packages for [vaginal] delivery ranged from 4,060 to 23,100 pesos, while prices for cesarean section ranged from 6,490 pesos to 34,762 pesos, excluding doctors’ fees, such as gynecologists, pediatricians, anesthesiologists and assistants.

 

Non-medical causes

Jesús Lujan, an obstetrician-gynecologist specializing in human reproductive medicine and the director of Clínica Pronatal says that cesarean sections are performed today  based on age-related factors, personality, doctor, country or place of birth, standard of living, environment, family, friends, media and even the Internet.

“Women are marked in advance by previous cesarean section, any uterine scar in general, and cephalopelvic disproportion, which is almost always an imprecise measure because not all professionals use the same parameters for diagnosis. Mothers are told that are too short and that we are sure your pelvis is smaller than the baby’s head, that they are too old and will be unable to handle birth, that the cord is tangled, that sex will never be the same, and many other lies,” says Lujan.

These lies have been told daily for the last 20 years.

In the 1960’s, 3% of all births were cesarean sections, and by 1990, the rate had risen to 30%. Today, the official rate of cesarean sections reaches 70% in private hospitals across the country; however, there are doctors like Dr. Lujan who are sure that the rate exceeds 90% in private hospitals.

[Lujan] clarifies that cesarean section may be necessary if there are changes in the presentation of the baby, such as turning breech, in a multiple pregnancy if infants are not well, which is not always necessary, if there is delay in uterine growth, i.e., if the baby is underweight or fetal macrosomia, which means that a baby weighs more than four kilograms.

In addition, a cesarean section may also be required if there are fetal abnormalities such as neural tube defects, fetal distress, cord prolapse (which is very rare), placenta previa or abruption, the presence of vaginal warts in the birth canal or if there are maternal diseases such as preeclampsia, gestational diabetes, advanced cervical cancer, genital herpes symptoms.

 

Photo credit: El Universal

 

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Reader Comments (11)

My apologies in advance for the mediocre translation. It wouldn't be publication worthy but the English version should be clear enough to convey points in context.

July 21, 2010 | Registered CommenterJill

WHY? WHY? WHY? I cant think of much else to say! REDICULOUS!!!!! There is no reason for this many unnecessary c sections! REDICULOUS!

July 21, 2010 | Unregistered CommenterROSE FLOWER

I am curious how c-sections are viewed in Mexican culture. In the US it still seems that while the idea of WANTING a c/s is growing, most women say they would like to avoid surgery, but then put themselves on the hospital conveyor belt not knowing what they are getting into. Is it a status symbol in Mexico to get the c/s?

July 21, 2010 | Unregistered CommenterWrangler Mama

I wondered the same thing as Wrangler Mama; is a c-section synonomous with status? It seems horribly misguided to think so, but is N.A culture selling major abdominal surgery as a luxury? I cannot imagine such numbers. 30% was a hard enough pill to swallow.

July 21, 2010 | Unregistered Commentermothersong

I'm Mexican doula and childbirth educator and I became those as a result of being another victim of an unnecesarean with my first baby. I was willing to have a VB but the butchers OB condemned me to a CS cause I had a back pain!?! I changed Ob at 7 months just to ending in a planned CS from my new OB. Unfortunately in the big cities in Mexico the great majority of women have wrong information and yes is a matter of status to have a big surgery which is "painless" and make her believe "I'm so slim and petite that my baby won't go out through my body, besides I can keep my vagina tight and my baby will be prettier since his head will be perfectly rounded and not molded" yikes!!! Besides the insurance (most of them) only cover CS but not vaginal births. However there's a new generation of women better informed (by childbirth educators :D) that are making a difference and being examples to other women...by other side, outside big cities the situation is quite different. The budget of the hospitals(non private) are limited and they encourage to have a VB before choosing a CS and there are midwives too that are so popular and a great percentage of women choose them. I had a CS in a private hospital and then with my second one I was so lucky to have a midwife and had a beautiful HWBAC. Now I live in Vancouver Canada.

July 22, 2010 | Unregistered CommenterDulce Lopez

I forgot to add my website www.iktanbirth.com

July 22, 2010 | Unregistered CommenterDulce Lopez

I don't know much about birth culture here in Ecuador yet, but I know that in the Middle East it was very much seen as a status symbol and a sign of the best care possible if you had a c-section. Doula Dulce Lopez listed all of the reasons I heard for the justification of cesareans as well. They seem to be pretty universal.

I do work with a girls' home here and there were two girls at the house who were pregnant. As part of my volunteer work there, I went with them to their prenatals here. The girls were told that they would *of course* need scheduled c-sections around 39 weeks because they had both had previous births by cesarean. I guess they don't do VBACs here, at least not at the largest public maternity hospital in the country. I was a little surprised to find that, considering the cost of a VBAC is lower and the recovery time afterwards is also usually much less complicated.

July 22, 2010 | Unregistered CommenterAugusta

By chance, does anybody know where I can find the cesarean rates for Ecuador?

July 22, 2010 | Unregistered CommenterAugusta

An study about Argentina that mentions socio-economic differences (sorry-not about MX but happened upon it while searching for Ecuador stuff):

"Interpretation: women from regions and provinces with low socioeconomics levels present a minor rate of caesarean receiving, therefore a better “standard of care in health”. In this particular case, poor women receive a better quality of medical attention and this “cultural inaccessibility” becomes a benefit for their health." (http://www.sogiba.org.ar/revista/042009/Niveles.pdf)

July 22, 2010 | Registered CommenterJill

thanks, mothersong!

July 22, 2010 | Unregistered CommenterWrangler Mama
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