I am finding the dynamics of women in Morocco who are active and want to remain active and healthy during their pregnancies, and doctors who cautiously put many women on bed rest interesting and a bit confusing. I think there must either be some grave conditions that are prevalent here that cause such a strict approach, or simply a contradiction in how pregnancy is viewed and how women’s bodies are viewed compared to the USA. Clearly the cultural differences are intense and dramatic. One childbirth practice that is common to both Morocco and the USA is frequent Cesarean Section Deliveries.
I am totally supportive of women having C sections when there is good reason to have one. But my skepticism comes partially from the historical and present pattern of the medical world not listening to women’s knowledge of their bodies or not believing them when they are providing important information for apt treatment. (See this article). I like to believe that most doctors are constantly working to improve their abilities to keep people alive and well. But, there are still issues that need to be examined both globally scale and within communities regarding the the treatment of mothers during childbirth.
In Morocco, women seem to be thought to be extra feeble when pregnant. In the USA pregnancy is literally considered a condition as a defect or cancer. It is amazing that the state of gestating a human is considered to be essentially an illness or handicap. This dynamic could easily lay the groundwork for women to be disbelieved or forced into doing something that might not be ideal.There is a well documented historical pattern in occidental medicine of male doctors using their “scientific” knowledge to reduce women’s understanding of their bodies. (Even more so for people and women of color).
Not very long ago, doctors in the USA would put women in a twilight state during birth to avoid extra trauma. My grandmother was an experienced nurse and trusted the wisdom of doctors like it was a second bible. However, when it came time to deliver her second child (my mother), she declined the twilight state; she wanted to be aware of her child’s birth. Her refusal went so far that she said she fought the doctors and resisted, but ultimately the medicine was administered to her and she was put under anyway. It was, they said, for her own good. Most doctors today, I believe, would agree that this was an error in procedure. Women are even usually kept awake during a C section.
Issues with delivery persist even today . While some women in more developed or affluent situations are rushed into and sometimes request cesarean section deliveries when they might not be advised, in places where women have no access to this procedure may very well die from lack of a life saving C section or suffer from birth injuries like fistulae. (For more information check out the book, Half the Sky which brilliantly postulates that the introduction of a basic cesarean section to a midwife or who ever assists with the birth process in that locality can potentially save thousands of women.) As a developing country where not every citizen has access to health care, Morocco is a place where both dynamics occur: women needing medical intervention and being essentially violated by medical intervention. Neither option is optimal.
In the USA, the C section rate appears to be about 30%. As I have been doing some research figuring out the rates of C section in Morocco are rather more complex. As a developing country, Morocco has statistically a lower incidence of C sections. That number does not square up with what I hear is happening in Casablanca. A good friend who has lived in Casablanca for a long time and gave birth to her daughter here, told me that she estimates the rate of C-Section births to be in the range of 99.9%. She in among that 99.9% and has only met one woman who was permitted to give birth vaginally. The alarming rates of C-section are also interesting when you consider that bed rest is a common practice. In the USA, the use of bed rest to treat a condition during pregnancy is very rare. I have been frequently told that if I have a choice, I should go to the USA should I get pregnant.
Another friend told me that her doctor would not permit her to continue to attempt her birth naturally simply because if something were to go wrong, she was afraid she would not have the support or resources to maintain the health of mother and child. It is surprising that a doctor would prefer to preform surgery, which can carry any number of risks, than allow perfectly healthy women to labor. The reason this doctor gave is much more comforting than doctors trying to make more money and expidite the birth.
One Moroccan woman was aghast when I told her considering the prevalance of C sections here, I would personally prefer to give birth in the USA. Her opinion of the care for women here in Morocco is quite high. It was the first time someone had encouraged me to attempt pregancy/birth in Morocco. Then, I learned that her father is an OB/GYN. She also pointed out that giving birth here is much less expensive than it is in the USA. She is absolutely right. According to the International Federation of Health Plans, delivery alone costs an average $10,000 in the US, while a Caesarean delivery costs over $15,000. (BBC article). Interestingly, at a birth center, the cost of a low risk birth averages around one third the cost of birth in a hospital. It also seems entirely possible that Doctors in Morocco prefer to put women under the knife instead of allowing them to birth naturally because they can then charge more money and move on more quickly to the next patient. It appears that doctors have forgotten that Cesarean Section is major surgery.
“Frequently there is more Danger from the Physician, than from the Distemper … but sometimes notwithstanding the Male Practice, Nature gets the better of the Doctor, and the Patient recovers.” Dr. Douglass, a physician from the 18th century.
Douglass was referring to Male Practice as opposed to the practice of primarily female healers in the United States who predate the establishment of Medicine in many areas of the US.While this quote discusses the fatality rate of colonial surgery, there are still risks to surgery today. When this is true, why make a healthy woman undergo surgery when she is delivering a healthy baby?
The risks of Cesarean Section include:
- Heavy blood loss.
- A blood clot in the legs or lungs.
- Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure).
- Bowel problems, such as constipation or when the intestines stop moving waste material normally (ileus).
- Injury to another organ (such as the bladder). This can occur during surgery.
- Maternal death (very rare). About 2 in 100,000 cesareans result in maternal death.1
Cesarean risks for the infant include:
- Injury during the delivery.
- Need for special care in the neonatal intensive care unit (NICU).3
- Immature lungs and breathing problems, if the due date has been miscalculated or the infant is delivered before 39 weeks of gestation.3, 4
Medical care for pregnant women at this juncture seems like food that is over abundant and rotting in one place while populations starve in another. I can respect that doctors everywhere must do their best to keep mother and child safe and healthy in the delivery process and during pregnancy. I am not a doctor and am not an expert in any way, however, as a woman who can choose where she will give birth (and in that I am extremely privileged), I feel better that I can choose a natural method if possible, and have medical help if needed.
It would benefit us as a global community to entertain a real discussion of how we view pregnancy, how that view of pregnancy relates to the biological reality, how to best support and treat pregnant women, and how to make medical care available for women who need it regardless of economic/geographic/socio-political restrictions. We must get past this system of distrusting women and dictating what is for their own good and actually use our knowledge to support the natural process.