**1. Introduction**

This study is anchored in the field of Anthropology of Biomedicine, which addresses an area of anthropological investigation focused on the influence of sociocultural aspects in the biomedical theories and practices. In this view, it is important to recognize that medicine is a cultural system as subject to anthropological analysis as any other context [1, 2]. Likewise, studies in unusual fields like Bruno Latour and Steve Woolgar's [3] in laboratory helped to put under perspective the production of scientific facts as topics of investigation in the social sciences.

In this line of reasoning, diagnostic and therapeutic interventions bring to the light political, economic and commercial issues in their ethical, clinical and philosophical dimensions. Such questions have lived up debates in Sociology of Science and Anthropology of Biomedicine with questionings like: What are the meanings and effects of these interventions on intimacy? How is the health/illness process

reconfigured in the daily life of the individuals in face of such interventions? How do health professionals remodel their practices and their relations with sick individuals in front of these new technological and scientific resources? Which is the accessibility and the ethical and cultural consequences of the intense development of these scientific technologies for the societies and the individuals? From the point of view of the Foucauldian notions of biopolitics and biopower, the debates show that the biotechnologies constantly use hegemony, inequality, and subordination to create social consumption in order to control both individuals and collectives. It is with this view that this study approaches the positioning of entities representing the physicians of Rio de Janeiro, Brazil on the excessive number of cesarean sections in the country, in counterpoint to the position of activists for humanized childbirth. The goal is to understand how the physicians conduct their discourses and practices concerning the contemporary issues on childbirth medicalization, specifically the C-section.

In Brazil, the rate of C-sections is considered way above any existing parameter. The World Health Organization (WHO) recommends a rate of 15% of C-sections in the country, although a slight increase can be presently observed in part of the developed countries [4]. In the United States, for instance, there was an increase from 20.7% in 1996 to 31.1% in 2006 [4]. In Brazil, current data indicate a rate of 53% of C-sections on the total labors in the country, existing a distinction between the rate for those conducted in the public sector (46%) when compared to those accomplished in the private health sector (88%), being considered that there is a "cesarean epidemic" in the country [5, 6].

The WHO recognizes that there is an "actual cesarean culture in the country, even when considering that local particularities make the definition of a unified goal difficult [4]. Thus, the organization advocates for the need to reduce C-sections in the country, claiming that this procedure "can cause significant, sometimes permanent complications, as well as sequelae or death" in mothers and babies.

Several works try to identify the causes of these high rates and the focus is always on the physicians. A great number of inquiries accuse them of carrying through procedures like C-sections because they are better remunerated [7]. Others point equally to the preference of physicians for carrying through procedures in schedules and days marked according to their own comfort [8, 9].

These arguments have been used also by the feminist activists for humanized childbirth to accuse the doctors of carrying through an excessive medicalization of labor in which the cesarean is the major representative. They also emphasize that the doctors do not privilege the autonomy of the women, do not appreciate their experience and do not respect all their citizenship rights related with the choice of their way of labor [10]. The activists claim that the doctors must respect the female physiology of the childbirth, not interfering unnecessarily, recognizing the social and cultural processes of labor and birth, providing emotional support to the woman and her family, facilitating the mother–child bond, and assuring her autonomy when choosing the way and the place where the childbirth will be carried through: at the hospital or at home. In the same way, they claim that the doctors must inform the woman on all the procedures [11–13].

There are several works dedicated to study the point of view of women on the cesarean childbirth [14, 15]. However, the medical reasons are little studied. Thus, this study will focus on the medical perspective. The universe of the study that will be presented here regards to the medical representatives of Federal Council of Medicine of Rio de Janeiro [16].

In Brazil, the agencies that inspect, regulate, and promote the doctors activities are the Federal and the Regional Councils. The Federal Council of Medicine é based

#### *In the Crossing of Politics With Science: Medical Arguments on the High Rate of Cesarean... DOI: http://dx.doi.org/10.5772/intechopen.97635*

in the Brasília, F.D. and has jurisdiction over the whole Brazilian territory. However, in each region, it works in partnership with the Regional Councils of Medicine (RCM). There are several RCMs in the country, as it is the case of Rio de Janeiro, the CREMERJ. The CREMERJ exists for 60 years and is formed by 42 council members who represent the several medical specialties.

The RCMs watch for the ethical principles of the profession in all Brazilian regions. They are autarchies with autonomy in their administration, keeping their own view, values, and financial management. For such, they make available information, documents, resolutions, and publications. In order to accomplish their activities, all doctors must be registered at the RCM of their state, being them, therefore, crucial for the exercise of the activity. Trying to enclose all professionals and specialties, the RCMs are subdivided to address each sector of medicine. They are the Chambers and Commissions, aimed to the medical specialties and other activities of the doctors, like clinic manager or health entrepreneur. Everything is inspected by the Council.

The regional councils are places of the medical elite with a political and scientificist aura. They assume the mission of appreciating the profession and they have the power to entitle or exclude doctors carrying through an ethical analysis of medicine. This leads us to the power of the medical class as already mentioned by Freidson: "The origin of the control of Medicine on its own work is, therefore, of a clear political character, involving the aid of the State in the establishment and preservation of the preeminence of the profession" ([17], p43).

Despite the advances, there still are huge gaps related to the strongly corporatist character of the profession. In this sense, the debate promoted by CREMERJ concerning the c-sections is exemplary. In this case, there is a straight confrontation with feminist militants who, to a large extent, are represented by the classic "enemies" of the profession, midwives and nurses. Not less relevant is the character of gender that historically crosses the childbirth medicalization, as the feminist militants are females and the medical representatives of CREMERJ are mostly males [18].

One of the tasks of CREMERJ is to develop events and debate meetings aimed to promote good medical practices. For this research, it was accomplished a participant observation of the "Symposium Childbirth and Abortion" (29 and 30 March, 2019), promoted by the entity between 29 and 30 of March [19]. It was also made the documental analysis of news published in its website, of documents produced by it and statements of its members to the media.

It is worth highlighting that the debate on C-section versus normal childbirth is quite polarized in the country. It has opposing political partisan contours: the ultraconservative right and the progressive left. It should be made here a brief retrospect of the current Brazilian context that livens up this debate.
