Never mind the World Cup—Brazil in the obstetric spotlight

With a shrinking world and a mobile healthcare workforce, it is important for midwives to be aware of what happens elsewhere. In June 2014, the International Congress of Midwives (ICM) holds its 30th congress in Prague—coincidentally the location of a discussion previously covered in this column (Symon, 2012). Sharing knowledge and experience with midwives from other countries can be enlightening, and can help us to appreciate better what we have come to expect in this country.

The debate about caesarean section rates will be familiar to most readers, and many will have heard that the situation in Brazil is particularly acute. In 2004 the Ministry of Health estimated a rate of 41.8% (Zizza et al, 2011), but there are reports that it is much higher in many hospitals, especially in the private health sector, where the rate is often well in excess of 80% (Hopkins et al, 2014). Demand from women has been cited as one of the causes of such a high rate, but even if demand from women for this operation may exist, most will assume that the operation is not performed against a woman's wishes. A cornerstone of our understanding in this country is that a caesarean section—with very few exceptions—can only be performed with the woman's consent. In describing a rare example of a court-ordered caesarean in the UK earlier this year (Symon, 2014) I stressed that the decision had only been reached after careful consideration had concluded that the woman was not mentally competent. After discussion with the woman's family, the course of action was also believed objectively to be in her best interests.