Routine and Obscene: Birthing in Oaxaca Part II

12 Apr

Life is messy, and birth is super messy. No matter how you birth, C-section or vaginal, in a pool while listening to jazz or screaming like a banshee at that dumb-ass doctor, it is full of messy body fluids and messy emotions. There is no sterile birth. The whole messy shebang- pregnancy, birth, and the never-ending afterwards is a wild medley of joy and misery for most people. Your body is totally hijacked by this creature and just about everything in life therefore becomes about this creature, which is maddening some of the time even if you had to work hard to get that creature in there. But here’s the thing: it’s still your body, and everybody, every body, every baby, and every body carrying a baby, deserves respect. Period. You deserve respect. You deserve information and you deserve care. No ifs, ands, or buts.

So this is about to be messy, y’all. This is approximately my 18th attempt to finish and publish a blog post about this topic, but I am over-the-top-determined, fired-up and mad and impassioned all over again. So brace yourselves. I am bringing the mess.

Now, let me be clear. I’m about to get very detailed and slightly rabid over doctors, nurses, education, and health care in the state of Oaxaca, Mexico (especially the coast, since that’s where I live.) But that does not mean that this does not apply to you, too, my darling USA. Do not- I repeat, Do Not- go around patting yourself on the back that you’re doing better than Mexico, or that you don’t need to worry about it because you’re safe up there in the North. Do not fool yourself. Mexico learned a lot of these tactics from the US in the first place. The problem is, Mexico ends up scoring higher on the charts at all the wrong things. Soda consumption? Mexico wins! Type 2 Diabetes? Another goal for Mexico. Cesarean births? Mexico is kicking the US’s butt again!

So there are the fews stats I have: “…(T)he maternal mortality rate in Oaxaca is approximately 62 maternal deaths per 100,000 live births, double the national rate,” according to Child Family Health International. The US has about a third of its births via C-section, when the World Health Organization suggests that a C-section is medically necessary about 10-15% of the time. Around here in Oaxaca, it’s hard to get solid statistics*, but it’s estimated that 50% of births terminate in a Cesarean, and that the rate of C-sections is even higher in private clinics, with some estimates at high as 80%. Such a high C-section rate brings much higher risks and worse birth outcomes for both mother and child. And that’s only part of the story of what’s wrong with birthing in Oaxaca.

References: WHO C-Section Statementmortality ratein Spanish, more information about the state of giving birth in Mexicomore info in Spanish, more info on estimated rates  (I am not very familiar with the publisher of the information in Spanish, so I can’t vouch for how definite it is, but it is just about the only information I can find.)

Now, I studied sociology and everything in me is against relying on anecdotal evidence as fact, but in the absence of well-researched statistics, I think anecdotal evidence is worth a mention. This is a big part of what has had me crying and wringing my hands and pumping my fists alternately in these nearly 5 years of living down here- the birth stories that I hear. This is what is going to be my long-term mission to join with others in the community to change, if I end up living here forever: humanizing pregnancy and birth.

It’s ugly in the public sector and it’s ugly in the private sector, but your treatment is drastically worse the poorer you are. In the news there are loads of stories about women who were forced to give birth in the parking lot, on the lawn, in the bathroom, in the waiting room, etc., because there wasn’t enough space for them in the hospital/clinic when they came in. The women that this happens to are always indigenous, but luckily there is no racism here (yes, this is sarcasm). I suppose that’s the worst end of the spectrum, although I’m not sure the care that people receive when you’re admitted qualifies as desirable, either. Yes, it is better than giving birth outside with nothing, but is that really what we’re willing to accept?

What always strikes me as the worst acceptable, routine thing, is that women are giving birth alone. Labor and delivery is one of the hardest and most beautiful and wildest and messiest things you can do in life, and that’s cool if you choose to do it alone. Anytime you give birth in the public sector, though, you have to be alone. All by yourself, with just a bunch of other women around who are also in labor, with not enough doctors and nurses or even, sometimes, enough beds. ALONE! With no one to advocate for you, for your health and wellbeing, for the baby’s health and wellbeing. With no one to hold your hand, to rub your back, to get that hair out of your face, to tell you that you’re doing great and it’ll all be over eventually. Alone! For your entire labor and delivery. Already that, in and of itself, is completely and utterly inhumane to me. I can. not. fathom. it. And it pisses me off extra here in Oaxaca because if you go to the hospital for ANY other reason, they force someone to accompany you. If you have to be recovering from something in the hospital for 3 months, you have to have someone there, just about 24 hours a day, because there aren’t enough resources for the hospital to take good care of you. So why the hell would you send people in to give birth totally on their own?! Heartless bastards! I suspect it’s partially because they don’t want anyone there to defend you and help take care of you.
Let me tell you what kinds of things happen there, while you’re there, contracting and alone. You don’t get any water. I know, many places in the US like to do this too, which is equally senseless and unnecessary, but it’s even more cruel here, where it’s 85 degrees and more humid than Hades. One friend told me that they STILL wouldn’t give her water or food for hours after her birth. Finally she begged a doctor for water and he told her it was at her own risk- as if water was going to do her harm after giving birth!

Furthermore, more than one person has told me that nurses berated them for making too much noise. You’re often in a big room with a ton of beds filled with other laboring women, receiving little attention. One woman just told me that during her birth, they decided that she wasn’t progressing fast enough (normal), but there were no gynecologists in at the time. Therefore she had to wait another 12 hours for the gynecologist to come on call, and then they could only give her a C-section because they decided it was too late to try to speed up her labor any other way (which is a pretty common story in the public sector, due to lack of gynecologists).

Then there are all the excuses they give you to have an unnecessary C-section, especially in the private sector. The cord is wrapped around the baby’s neck. The baby is too big. You’re a couple days past forty weeks. Your hips are too small. You already had one C-section. Ad infinitum.

All of this is similar to stuff they might tell you in the US, but the difference here is that there is no such thing as pregnancy and birth education. There are no child birthing classes. There is no education about what to expect while pregnant even. If you have a doctor like the one I had at the insurance company, they don’t even tell you basic information like when to suspect there is a problem. Culturally, there is no questioning authority. So if the doctor says your baby is too big for you to give birth to, you don’t ask how he or she knows that. You either accept it and get the C-section like they want or you reject the system entirely and go to a midwife, which could or could not be a good option. (More about midwives in another post, I promise- it’s too broad a subject to broach). Many people don’t have the option of midwives, or of anything beyond the very limited bit their health insurance provides.

If you do have the money or borrow the money to give birth elsewhere, it ends up being a similar scenario. The private sector thrives on your ignorance and the total lack of available options, on the fact that almost all the doctors are out to screw you over equally. For example, one prominent gynecologist here told me beforehand that if I didn’t want an automatic episiotomy, that I would have to sign a bunch of consent forms beforehand, and that, you know, it was all at my own risk, because that made it very dangerous! It felt to me like they just make stuff up to sell you more services you desperately “need”- and if it turns out you need a C-section, (which you probably will), then even better, because it’s more convenient and way more money for them. (Multiple people have sworn to me that doctor friends have even admitted this is how they operate.)

On top of treating women like animals in labor, often doctors take the opportunity to abuse their power and your reproductive health and rights while you’re there. The straw that broke the camel’s back in forcing me to finally publish this messy, disorganized blog post about this was hearing ANOTHER story of forced birth control. This story came directly from a doctor who had no reason to make it up. We were talking about IUDs, and how sometimes the strings hang down too short, and he was telling me that he just had a case where a woman had been trying to get pregnant with her second child for years, She had had all kinds of testing done and everything, and they couldn’t figure out what was wrong. Finally, it turned out that she had an IUD in place, that had been put there when she had her first child via C-section, without her consent or knowledge. Apparently this is a common thing- giving women an IUD, either without their knowledge at all, or forcibly without their consent. Another second hand story came to me about a woman getting a forced IUD and the doctor telling her, “I don’t want to see you in here pregnant again for the next few years!” Which I can totally imagine, because that is how doctors talk to people here, especially to women.

Of course they do the same thing with sterilizing women. They pressure you into it if they decide you have enough children. Just this weekend I was chatting about this with someone who experienced it. They tried to force her to get a tubal ligation when she gave birth to her fourth child. “How many children do you have? Don’t you think four is enough?” The doctor tried to shame her. This woman is a total heroin, though- she is the same woman my nurse friend told me about who REFUSED to let the doctor put his hand in her uterus to “clean her out” after birth (another routine, unnecessary, and very painful procedure). She was like, “I came to deliver my baby, not to get surgery, thank you.” She said the doctor wouldn’t leave her alone about it until another doctor who is her neighbor came in and defended her right to decide. Your rights mean nothing. She got to decide because a man in power intervened on her behalf.

I could rattle on and on about more abhorrent stories and accounts, more abuse and lack of rights, but here’s the end game for me: We need more education in the community, AND a total shift in the system. Let’s stop reading about another indigenous woman giving birth on the lawn of IMSS and acting like it doesn’t affect us. Let’s stop listening to each others’ horror stories. It does affect us. It means that we are accepting this as the care that we deserve.  Giving birth is messy but it shouldn’t be dehumanizing. Being routine does not make something acceptable.

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