Caesareans have become festive events in Brazil, where they are more common than natural births

TWomen with white gloves place chocolates and cakes on silver trays. They fill the crystal vases with roses. Now, the guests are coming. Mariana Casmalla was polite, prepared and polite in anticipation of this moment.

She is ready for her caesarean section.

"It's a special occasion," says Casmalla, a 28-year-old dental surgeon, hitting eyes made up by professionals.

"Do not we dress for parties and special dates? It's the same thing. "

Optional cesareans have long been a symbol of status among the Brazilian elite, allowing some of the richest women in the country to avoid the unpredictability of natural childbirth. The country has one of the highest caesarean birth rates in the world – they account for 55.5% of deliveries in Brazil, compared with 84% in private hospitals, according to the Ministry of Public Health. In the United States, the rate for all hospitals is 32.9% and about 29% in the United Kingdom.

Now, the phenomenon is inspiring a new industry of holiday planners, make-up artists and caterers, focused on transforming these highly orchestrated operations into wedding shows, produced for an audience.

The main event: the birth itself, seen by family and friends from a gallery built for this purpose.

At Sao Luiz private hospital in Sao Paulo, a future mother can get her hair done and put on her hospital room. For R $ 2,000 a day – around £ 400 – her family can rent the Presidential Suite, which includes a living room and bathroom, a balcony and a minibar. Mothers can request their favorite magazines and flowers, and even change the furniture if it strikes their intended decorations. A 22-storey maternity hospital currently under construction will include a wine cellar and a ballroom.

"It's cultural," says Marcia da Costa, director of the hospital. "Brazilians want to plan everything. They do not want to hit the traffic on the way to the hospital. They want to wax their nails, make wax, plan it as an event. "

Nevertheless, da Costa and other health professionals are ambivalent. The World Health Organization has a long history of campaigning to reduce elective cesarean section, which is almost twice as deadly for mothers as natural births and requires a longer recovery period for mothers and babies.

In Brazil, public health officials and some of the country's leading doctors have been trying to heal the upper clbad of its penchant for the procedure.

Costs vary, but caesareans are usually more expensive than natural births. While the risk of maternal death in well-equipped private hospitals is low, hemorrhaging and infection are more likely during a scheduled cesarean section than during a natural birth. For babies, caesareans have been badociated with higher rates of respiratory distress, diabetes, and hypertension.

The WHO estimates that about 10% of births require a cesarean section.

"Here we had the opposite statistics," says Rodrigo Aguiar, director of Brazil's National Health Agency, which regulates private hospitals.

The numbers are even more pronounced during the vacation months, he says, when women and doctors request elective caesareans before the baby is ready to be born. This leads to higher rates of respiratory problems in infants and extended hospital stays for mothers and babies.

"We found that we needed to reevaluate these percentages and make sure that birth decisions were focused on the health of the mother and the child, not for convenience," says Aguiar.

The Brazilian Ministry of Health has taken steps to reduce what it calls the caesarean section outbreak. In 2016, the government banned medically unnecessary caesarean sections by 39 weeks.

Historically, Brazilian women have had good reason to fear a natural birth. As the country's public health system was overburdened, doctors and nurses lacked the resources to monitor women closely during working hours. Caesareans have allowed staff to monitor mothers closely for a short time.

In private hospitals, the procedure has won in favor of both mothers – who want their personal doctors, not hospital call staff on call, to give birth to their babies – and doctors who juggle with busy schedules.

Olimpio de Moraes Filho, president of the Brazilian Federation of Obstetrics and Gynecology, said cesarean sections fit certain lifestyles.

"Caesareans are now a lot safer than they were 30 years ago," he says. "Things are changing, women are in the labor market, couples are trying to plan a time when the family can come together."

At the Albert Einstein Maternity Hospital in Sao Paulo, the party begins before the baby is born. A frosted window overlooking the operating room becomes transparent to the operation, allowing guests to see the moment of birth.

While Casmalla is driving into her operating room, 15 members of her family and close friends are lagging behind. They gather around the window, their ears glued to the wall, listening to the baby's first moan.

When the doctor pulls Lorena from the incision in the abdomen of Casmalla, the window becomes transparent. Casmalla gives a boost to the public.

"She is here!" Said Marisol, Casmalla's mother-in-law, in tears. Families who watch on FaceTime ask to be more attentive.

Paula Ascar Baracat is co-founder of Estudio Matre, a party planning service specializing in maternity clinics. She says new mothers increasingly prefer to receive guests at the hospital rather than at home.

"The mother has just given birth, she is learning to badfeed, she does not want to receive at home," says Baracat. "So while she is preparing for birth, we are preparing to welcome."

Baracat customers spend more than $ 10,000 for services such as floral arrangements, guestbooks, monogrammed sheets, custom water bottles and silver favors for guests.

Women with natural births often use these services. Nina Materna, another party planning service, has three hotlines that women can call when they give birth. The company promises to have fully sterilized decorations within eight hours. But caesareans give mothers another level of planning.

In 2015, Linus Pauling Fascina, Director of Maternity in Einstein, brought together doctors, doulas, midwives, feminist activists and government officials to discuss ways to increase natural birth rates in private hospitals Brazilians.

The group launched the appropriate birth project, a partnership with 35 hospitals to prioritize natural deliveries among the country's elite.

One of their first steps has been to bring the luxury and family experience badociated with Caesareans to natural childbirth.

Einstein Hospital has opened five new natural birth centers with private showers and bathtubs. In Sao Luiz, women who give birth naturally can choose the color of their hot tub lighting in the room. The fairy lights on the ceiling can turn blue or red, depending on the mood of the patient. All rooms are equipped with MP3 players that patients can load with customized playlists.

The results came quickly. In four years, the rate of natural births in Einstein has gone from 18% to almost 50%. The program has been extended to more than 200 hospitals.

"The changes must be concomitant for everyone: women, their families, their workplace, their doctors, their nurses," says Fascina. "When the husband comes in and says," I work, I need to know the date of birth "- you have to learn how to plan for what is impossible to plan."

For Bruna Viera, 32, a natural birth was always out of the question.

"It does not fit with our lifestyle," she says. "I am a doctor and my husband is too. We have a very planned life and had to take a vacation for the baby to be born.

Viera spent weeks preparing drinks and decorations at her maternity ward in Sao Luiz. When baby Arthur made his debut last month, his hospital room was decorated with blue and white balloons, his fridge was filled with beer aged in barrels of rum, and the table of his luxury suite was lined succulent plants. the 80 guests she was waiting for this weekend.

"I like that," she says. "You feel the tenderness that people have for you. Many moms suffer from postpartum depression and feel isolated. Your hormones are raging. But being surrounded by people we love, people who have seen you grow up, is amazing. "

Half a dozen friends of the mother coo in front of the baby, her husband opens a bottle of wine.

Grandmother Lucimeire Viera balances baby Arthur in her arms while holding a glbad of Merlot.

"See, honey," she explains to the baby. "Life is a party."

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