•Region III’s patients experience poor birthing agency.
•Birth outcomes are understood as pure chance: “I’d like a natural delivery, but we’ll see if I get lucky.”
•Home birth (and/or un-medicalized deliveries) are understood as resulting in near-certain death.
•Preferences are shaped almost exclusively by amount and duration of pain. Differences in health outcomes are generally not factored into birthing preferences.
•Fetal distress is a “lie”, as the female OB/GYN told me. It is being diagnosed without objective indications and is legitimizing unnecessary cesarean use.
•Fetal distress is often diagnosed as a result of prolonged labor; after several hours in labor without progress, the medical team becomes nervous, and a cesarean is used. For this reason, the female OB/GYN states that the real cause of cesarean overuse is “fear in the administration”.
•Although elective cesareans are not offered in the public hospital, a bargaining complex still exists. Once a patient and/or her family wants a cesarean, a physician may capitulate, in order to “alleviate the patient’s suffering”, as the male general surgeon told me.
Perceptions about cesareans:
•Cesareans are generally understood as less desirable, more dangerous, and more painful.
•Almost every respondent without a previous cesarean prefers to birth naturally.
•Patients often refer to a poor “cleaning out” of their system after cesareans. They believe that gauze, scissors, blades, and gloves are often left inside the body.
•Patients fear cesareans because of back pain, resulting from epidural analgesia.
Perceptions about natural birth:
•Natural birth is generally understood as more desirable, safer, yet incredibly dangerous when attempted without a medical team. Its duration is grossly underestimated.
•Most women prefer natural birth due to its quick recovery.
•Overuse of episiotomies unnecessarily add to the fear of natural delivery.
•Prenatal education relies almost entirely on patients’ social interactions. Prenatal check-ups are not educational; physicians simply weigh, measure, and record progress.
•Enacting a prenatal education program could aid in shaping women’s perceptions, expectations, and knowledge about healthy pregnancies and deliveries.
Possible protocol changes:
•Vaginal Birth After Cesarean (VBAC) is generally not practiced in the Dominican Republic. Many women are experiencing unnecessary cesareans because of this anti-VBAC protocol.
•Indicators of fetal distress, cephalo-pelvic disproportion, and prolonged labor need to be more objectively defined and taught to the medical team.