All language subtitles for O.Renascimento.do.Parto.DVDRip.XviD

Becoming a mother
was my first concern.

The way she would be born didn't
really matter to me.

l only wanted her to be healthy.

l thought l was preparing myself
for a natural birth

by doing yoga and talking to people
who had already had

a normal birth.
But now l'm aware

l didn't have any information
about

the physiology of a natural birth
and its importance to the baby

MOTHER AND BlOLOGlST
and the mother.
l didn't take it into consideration.

What l took into consideration was
my anxiety and the doctor's opinion.

He cared more about his
valuable time

than about my daughter's life.

When l went to the doctor's,
the ultrasound report

showed a nuchal cord.
He said:

''She has a loop of umbilical cord
around her neck which may kill her.''

When a mother hears that and
she isn't prepared

and has never heard anything about it
until that point: ''What do l do?''

l asked the doctor and he said:

''Let's schedule a C-section to avoid
such thing from happening.''

l was 38 weeks and 2 days pregnant

and the C-section was scheduled
for the next day.

Everything went just fine,
my post-op recovery was nice,

the baby's APGAR was good.
So to me

it was a perfect delivery in which
my daughter was born well.

And as soon as l got pregnant
with my second daughter,

the first one was 3 years old only;
l showed her what it was like

to have a baby in the belly and
what it was like to be born.

So l took out the video from
the day she was born.

And she was shocked;
l was shocked,

even though l had seen the video
several times before.

But at that moment l was touched
because she kept asking

''Mom, why am l alone? l was born
and there is nobody with me.''

She was, as she said it herself,
abandoned.

She didn't use these exact words,
but it was something like

''You left Maria Luisa alone, mom.
Why?

l was in your belly and now l'm alone.
Where are you? Where's dad?''

l watched my daughter
come out of me,

the way she was taken out,
being shown very quickly to me

by a pediatrician who didn't
allow her to come closer.

l asked them to untie me,
but they didn't.

After watching the video that
l could realize

the way they treated her,
making her go through

several procedures
l consider highly unnecessary.

Moreover, it was cold, there was
a bright light in her eyes,

she was crying.
Besides being brutally taken out,

she had to go through all that during
her first minute of life.

At that moment l made up my mind:

my next daughter will be born
the most natural way possible.

This is not going to happen again.

And l sought for information to know

why and what l could do,
so that my child could be born well...

and l found it.

''BlRTH REBORN''

A FlLM BY �RlCA DE PAULA
AND EDUARDO CHAUVET

We are lucky to be dealing with
an issue

that has to do with everyone.

Everyone was born and most
people will desire to have a child.

So this subject is related
to the whole society.

SClENTlST AND OB-GYN

lndeed, there are stories
telling us that labor during

the pre-agricultural civilization was
much simpler and much faster.

The way childbirth is assisted in
contemporary industrialized societies

is a very new event if we take
into consideration

the time we have been on Earth.

Childbirth used to be something
absolutely of women among women.

From that time on,
there have been several changes.

Technological breakthrough,

the doctor as a new player
in the childbirth scenario...

And of course, by the time
we place women inside a hospital,

two other situations come historically:

horizontal delivery and episiotomy.

The entrance of men in the sacred
and hidden universe of birth

ended up bringing along,
with the lights of reasoning,

a change in the models and
paradigms of childbirth.

Not very long ago, a huge amount
of babies used to be born at home,

were attended by people from
their community, by women.

NURSE-MlDWlFE, PHD
Of course that at that time,

if there was a problem,

mother and baby would die,

something that doesn't happen
nowadays because we can combine

modern science
and ancient knowledge.

Women have been going to a place
specifically built

to assist sick people,
such as a hospital,

for only 40 or 50 years.
Therefore,

it has been a very abrupt
transformation of a family,

OB-GYN
affectionate event surrounded
by people known to the woman

and where she exerted
a certain control

into an event in an absolutely
inhospitable place

with people who are complete
strangers to her everyday life,

full of machines. Thus it is quite
a scary place for most women.

lt is no wonder that many women
upon arrival to the hospital

start presenting problems which
will subsequently be treated

with further added technology
by the doctors.

CURRENT REALlTY

ANTHROPOLOGlST, PHD

When women went to the hospitals
to have their children,

as in a mass migration,
they lost their power over birth.

They handed it over to the doctors.

They ended up settling to rigid
patterns established

by the medical system in which one
has to deliver within a number of hours

and behave in a standardized way.

Oxytocin, endorphin,
prolactin and even adrenalin

are fundamental to the bonding
phenomenon

between the mother and child.

These are extremely
important hormones

that are secreted during birth process

in a very subtle way.

We are not able to give birth
like our mothers used to...

my mother had 3 normal deliveries.
Or like my grandmother.

MOTHER AND PUBLlC MANAGER
ln fact, we ask ourselves:
''What is happening with our bodies,

with our history, that we're
not able to do anymore

what should be normal, right?

''Do what other mammals,
other animals do.''

Highly technology-oriented,
childbirth model of care in Brazil

has slowly created

MlNlSTRY OF HEALTH OFFlClAL
a cultural phenomenon in which
C-sections are the most comfortable

mode of birth, perhaps more suitable
to this consumer society.

The world today is prone to put
you into an OR for a C-section.

l have understood that is a fact.

Nowadays, childbirth in Brazil has
become a surgical procedure

rather than a physiological event.

NURSE-MlDWlFE
Everyone sees delivery as
a surgical procedure:

the doctor, the patient,
the hospital.

Brazilian health system
is ineffective, right?

Even private health insurance
can't assist the way they should.

ln regard to pregnant patients,
it is a true increasing fact.

ln a prenatal appointment today,
a fifteen-minute appointment,

you can't even clarify your doubts.

1 5 minutes is the time it takes
for you to lie down,

for the doctor to measure your blood
pressure and listen to your baby

and you get up. How can a doctor
afford to keep his office open,

on business, right,
with a 1 5-dollar fee?

We are all taxpayers and
we are paying

EPlDEMlOLOGlST, PHD
for an assistance which is
either inappropriate

or endangers the lives
of women and babies.

Nowadays, our cesarean rate,
to our sorrow,

exceeded 50�/�.

We have a 52�/� cesarean rate
in Brazil.

There is a cultural and
economic logic behind this.

There's a reason for that
to have happened.

The patient has this thinking
that C-section is more controlled,

it is less risky, that it does not
carry any risks,

that her baby will be saved.
The doctor, on the other hand,

despite having learned that
vaginal birth is safe,

that it's good for the mother
and baby,

he ends up believing a little
in some of this false truth

that C-section is safer.

THE lNDUSTRY OF BlRTH

l was very young,
l was 22, 23 years old

and l still had no idea of this
world of C-sections.

MOTHER AND DlETlClAN
l thought it was possible to
have a normal birth,

in fact, the doctor led me to believe
this until the end of pregnancy,

''No doubt you will have a normal birth,
don't worry about it, everything is OK.''

And suddenly she said that
Pedro had the umbilical cord

wrapped twice around his neck
and that was the explanation

she gave me so that Pedro
would be born by C-section.

l was very young.
l truly believed her,

but there was something in
my unconscious,

something telling me that
l was wrong, it wasn't that way.

Who would switch doctors
at 38-39 weeks, going against her?

lf there is any problem...
and the whole family saying

''You must give birth now''.

And then l ended up
having the C- section.

FATHER AND ACTOR
Sure it's business! For the doctor
it is much better to perform

a C-section. Of course there are
exceptions, there are people

who have a little more common sense
and actually wait for birth,

but most of them, they say they
prefer doing a C-section.

The amount of time one spends
attending birth doesn't fit

in the time schedule
of many professionals.

The amount of money private health
insurance pays isn't worth

cancelling your private
office appointments.

You earn more on one afternoon at
the office than attending a birth.

And we can't evade reality.

Many C-sections are performed
due to doctor's convenience.

We see a lot more NlCU
admissions

PEDlATRlClAN
the day before major holidays

because on those dates C-sections
are performed more frequently

as obviously doctors want to spend
the holiday without the risk

of being forced to leave home
to attend a birth.

But that's part of our choice.
We chose this specialty.

OB-GYN, PHD
When interviewing postpartum women,

they often believe that there was

a medical indication
for their C-sections.

When we interview doctors,
they blame

women's decision
for their C-sections.

They are women who are sometimes
in their first pregnancy,

who are slaughtered in a cesarean,
without the slightest mercy or pity.

MOTHER AND ACCOUNTANT
At first l had no idea about
the type of birth l wanted.

l was afraid but l started to find out
that normal birth

was really the best. l did a lot
of research through internet,

chatting with friends.
And then it started like this:

friends referred me to
their doctors, right?

But most of them wanted me
to have a C-section.

They tried to persuade me
into a C-section.

l would go and say: ''Doc,

tell me about natural childbirth.''
And he replied:

''No, Amanda, normal delivery?
No, that doesn't exist anymore.''

He would say that nowadays
C-sections are quick.

You have one, go home, recover,
and there is no problem at all.

But this was just one doctor.
After that

l still had three appointments
with him,

but then he was scaring me and my
desire for a normal birth increased.

Now, think from the
hospital perspective.

What would you prefer?
One patient, like a pregnant woman,

who will deliver a baby and will not
spend anything from that hospital,

she will basically pay for
her hospital stay,

because in a natural birth you
spend what? Compress,

gauze, nothing else.
So for the hospital

it is much more interesting to get
that conveniently scheduled patient

that they can count how many patients
there will be during that day, right?

The OR moves smoothly and orderly...

When a laboring woman arrives,
the party is over, isn't it?

For twelve hours that OR
cannot be used

because there's a laboring
woman there.

lt is a multifactorial problem;
there isn't a character

CERTlFlED PROFESSlONAL MlDWlFE
such as the big bad
wolf in this story.

There are interests that intertwine.

But one of the things we hear most
is that women ask for C-sections

and then there are two aspects:
firstly, if a woman thinks

that her option is that horrendous
birth, when she is abandoned

and she has no privacy,
there's cutting and pain,

she asks for cesarean.
And the second aspect is that

this woman who actually asks
for a C-section, she exists,

but she is a minority in Brazil.

There is research on that.
Potter's work,

in collaboration with
Professor Fa�ndes, has shown

that only 20�/� of women in early
pregnancy preferred C-section.

Most women get pregnant and say
''l wish l have a normal birth''.

As prenatal care continues,
she changes her mind.

And sometimes things are very subtle
like, ''Wow, what a big baby,

you know, do you think it's
going to pass? Difficult, right,

a big baby like that!'' This is only to
undermine women's self-confidence.

''Oh, do you want a normal birth?
Congratulations,

because it hurts a lot, it is very
difficult, you are quite brave.''

That kind of subliminal message
that normal birth is difficult,

painful, a difficult challenge
to overcome,

already undermining her confidence.
She says

''Hey, it's true, am l ready for that?''

Three weeks before my due date,
he said that even though

she was head down and engaged,
she was too large.

Then he asked me to do an ultrasound
with a doctor he referred me to.

We saw my baby moving.
Everything was fine.

Then we saw a frozen image with
a baby with the umbilical cord

wrapped around her
neck three times.

And at that moment we realized
that it was not our daughter

on the screen and we told him,
showing distrust

MOTHER AND PROFESSOR
and he changed the subject.
We left

and headed to another clinic
where there was a doctor

whom we trusted, that attended
my first birth, my first pregnancy.

Then l did the ultrasound there
half an hour later

and there was no loop of umbilical
cord around her neck.

That day l returned
to my doctor's office

and showed him the second ultrasound
without the loop around her neck.

He said ''Oh, you didn't have
the ultrasound done

with the doctor that l recommended?''
l said ''No,

l preferred to have it done by
this doctor, whom l trust.''

He said, ''The thing is that your
baby is big. l can't deliver her.

You'll have to have C-section.''
l said,

''Doctor, can't l even wait,
you know, wait for contractions,

have any sign that she is ready
to be born?'' He said

''No, we can schedule.
l have a day, next Wednesday.

lf you want to schedule C-section,
l'll do it for you;

if not, you can find
another doctor.''

For those who know how
to perform surgeries,

it's the curse of the scalpel,
a very easy solution.

You must have philosophical principles
and very strong convictions

not to give in to this temptation.

There are some private health
insurances that pay out only $90

for a doctor to attend a birth.
Ninety dollars!

lt's a great responsibility,
you have to be available

since the patient enters the ninth
month, you have to be available

for her night and day,
from dusk till dawn.

l guess it's the only specialty that
you have two lives in your hands

all the time, in a hospital where
there isn't any kind of support,

no physical structure.

Then there comes a point
when you get tired.

Still, many doctors start their
careers attending vaginal births,

they struggle to do so, as time
goes by, that starts to fade away

if you don't have
very strong convictions.

That creates a feeling
of dissatisfaction, and then

you decide you don't want
any of that anymore.

MYTHS

Many myths have been created
about the risks, right,

and you, as a protective mother,
what do you do?

You want to minimize them.
And then someone asks you:

''Do you want your baby to suffer
greater or minor risks?''

So, if you want to talk about risks,
stop, study, read and understand

which risks exist in each line
of thought.

Prenatal myths are numerous.

We find them in beauty salons in
those chats about

my neighbor's cousin.
''My neighbor's cousin

tried a vaginal birth and
something horrible happened.''

At the doctor's the myths we find
are: the baby is big and won't pass;

the woman is old, she can't birth -
and by old l mean she is over 30, 35.

That she is too young to give birth;
that she is too fat to give birth,

or too skinny; that she is sedentary;
that her vagina will become loose;

well... that it hurts a lot;
that if you have high blood pressure

you can't have a normal birth,
that a diabetic can't have it either...

Umbilical cord around baby's neck,
baby too big, baby too small,

advanced placenta maturity,
high or low amniotic fluid levels

are fake indications.
They are ghostly entities

that have been created
for cesarean indications.

One of the greatest excuses,
the champion of all,

is the cord wrapped around
the baby's neck.

lt's an absolutely physiological
finding and around 40�/� of the babies

are born with a loop of umbilical
cord around their necks,

but the myth of the ''killing cord''
has been created.

There isn't any chance of a baby
being strangled by his umbilical cord!

Another talk we hear a lot is

that the woman didn't
go into labor, which is,

you know, a lie because
all women go into labor.

Yet, if they perform a C-section
before labor starts,

then obviously she won't
go into labor.

But if we wait until 42 weeks,
that is the period of time

a pregnancy might last, women
will go into labor eventually.

We hear a lot about lack of dilation,
but this is extremely rare.

ln most cases referred
as lack of dilation,

there wasn't any respect
for what is physiological;

women were admitted
to the hospital too early

or not in active labor.

lt takes patience and waiting

as dilation won't happen
as if by magic.

l remember asking my doctor:
''ls everything all right with him?''

Because l told her that once born,
l wanted him to come to me,

l was already not happy with
that C-section, alright?

''Look, when he is born, please,
leave him with me''.

And l kept asking if everything was OK
and no one would answer me!

And l was worried because Pedro
had to go to another corner

with the pediatrician.
l couldn't stop

asking if everything was
alright with him!

Then she came to me
and said ''Andrea!

Everything is fine with your son,
calm down!'' Just like that.

And l said: ''Ok, everything is fine,
but l want him here with me.''

You know, l was so fragile with
such rude answer she gave me.

And she was so insensitive,
you know,

in such an important moment for me,
she didn't respect that.

Because for her, it's just another
one, isn't it? lt's different.

For her it was just another one
being born.

CESAREAN SURGERY

Cesarean is a wonderful surgery
that saves lives every day,

but it is not to be performed
in every patient,

in an unnecessary way,
electively, without labor.

When it is non-medically indicated,
it puts woman and baby at risk,

three times more than
in a normal delivery.

For the baby, the risk of an
unnecessary cesarean surgery

is the risk of being born
prematurely.

Ultrasound, for instance,
is important

to estimate gestational age
until 1 3 weeks.

lt is more accurate
in this period.

Near the end of pregnancy the margin
of error increases to plus or minus

two weeks in predicting a due date.
Some scientific studies have shown

that this error is frequently
for less.

Therefore, we think the baby
is 37 or 38 weeks

when in reality she is
two weeks younger.

Nowadays this is what we call
a hidden epidemic,

which happens in
higher social classes

and it's becoming almost natural
that the way to be born

is through a C-section.

And it's a scheduled
cesarean section.

And what comes as a consequence
is that premature babies

are being brought into this world.
Babies that very often need to go

to the NlCU and suffer all the
repercussion of being premature,

not ready to be born.

Among lay public the idea that
remains is that the C-section

saved that baby. lf the baby was
born in bad conditions by C-section,

imagine if the mother had
waited 3 weeks longer!

Under what conditions would
this baby be born?

lf there is one thing we can say
that is really radical, that's birth.

lt's true, clamping the cord,
abstracting from all symbolism in it.

You are connected to a placenta
that is attached to your mother,

everything biologically functioning
together, and then in the next second

you say ''now you are on your own'';

this is deeply radical

and that's exactly what happens
during a scheduled C-section.

World Health Organization studies
show that C-sections

without a well-defined clinical
indication are associated

with the increase of respiratory
complications for the newborn,

increasing chance of being
admitted into the neonatal lCU

and increase
in neonatal mortality.

For the mother there
is a higher risk

of hemorrhagic and infectious
complications,

let alone long-term complications.

Then one has to look
at greater populations,

cannot look at ten births but rather
check one thousand births at least.

And then we will identify that
in elective C-sections

there are more premature babies
being born, more infections,

more weaning, a more difficult
mother-baby bonding.

lt's evident that if born that way,

frequently the baby is not
given to her mother,

she is not allowed to nurse
in the OR,

no one waits for the birth to end
before all the procedures are done

with her, they take the baby away,
it's the same assembly line.

What l want to know is
''did we schedule with the baby

that she is going to be born
on Friday at 4 PM, and if we did,

did she answer that
she is ready to come?''

This is an impossible agreement!
That doesn't exist.

Then l switched doctors,
l had three appointments with him

and l felt l was being put on
the backburner, understand?

From the beginning
l told him l wanted to birth

and in one of the visits,
l was already 8 months pregnant

and he said: ''Look, Amanda,
l can't deliver your baby.''

Outraged, l started looking
for another doctor.

l had nothing else to do,
l was eight months pregnant,

l had to have the baby and l still
wanted to have a normal birth.

One day l felt sick and went to
a hospital, right, to an ER.

And l met this doctor, told him my
story, that l wanted a normal birth.

And he spoke like that: ''Well,
Amanda, you have a good pelvis,

we can deliver your baby''.
So l had my last prenatal visits

with this doctor and waited
for the day to come.

ESSENTlAL FEMALE DEFECTlVENESS

Human birth is an event that
has been molded over

five to seven million years
of experimentation.

ln spite of those million years
of improvement

culminating in the contemporary
obstetric model, it was fundamental

to create the idea that women
are essentially incompetent

and unable to handle the
birth process by themselves.

We were trained during
medical school to believe

that female's bodies are defective,
that a woman needs interventions

to be able to birth and that our
intervention is always necessary.

Women themselves believe
that they are unable

to give birth to their children in a
more natural and physiological way

because culture contaminates
their self-esteem.

And then, what should have essentially
been an empowering process

for them by the time they give life
and birth, has been transformed

into a process that fundamentally
strengthens doctors and corporations.

We have a lot to learn from
countryside women,

because they are
in close contact

with their own being
and with nature.

When they get pregnant, they do
not doubt whether or not

they are going to be able to give
birth. The brain doesn't get in the way,

you know? The mind of the modern
woman does get in the way.

We need to clear ourselves from
those mental contaminations,

this social idea that the woman
will not give birth because

MlDWlFE AND ANTHROPOLOGlST
women nowadays don't know
how to give birth anymore.

This is not true. We women,
we know how to give birth!

We enjoy giving birth.

l've always been skinny,
my hips are narrow,

l used to think l had
some kind of defect,

that l would never be able
to give birth until l got pregnant.

MOTHER AND PUBLlC SERVANT
l ended up switching OB doctors,
l heard stories

that the first would make up excuses.
After being able to give birth normally,

l realized l don't have
any defect,

l'm part of the Nature's perfection.

My daughter was born small,
she's not a big baby

and l am a small woman and
even then Nature is perfect.

The current Brazilian childbirth
model of care

- and in many other countries
around the world -

is doubtlessly based on pathology.

We sometimes end up doing what
we call prenatal nocebo effect,

when we label that woman,
you know...

''Either she has high or
low blood pressure,

too much or too little
amniotic fluid,

she puts on too much
or too little weight.''

These are minor issues that
are created to show

that this woman,
she has a problem.

Hardly does a woman leave
any prenatal visit saying:

''l'm great, l'm happy,
everything is alright''.

This is very cool, facing pregnancy
not as a state of tension, worries,

thinking that something might
go wrong, and yes...

''see, how nice, l am creating life!
A gorgeous pregnant woman!

Look how cool it is,
what a blessing, you know?''

An OB who worked for several years
in a reference hospital,

he has seen so many problems
that it's difficult to separate

the wheat from the chaff.

And most pregnancies are
healthy and normal,

but the complicated cases
make a real impression.

Today you arrive
at the doctor's and say:

l want to have a normal birth.
The classic answer is:

''lf everything is all right,
then you can have a normal birth''.

At the time you say
''if everything is all right'',

we almost reverse that: ''Of course
you are going to have a normal birth,

if something bad happens,
then you can't.''

l was here at home, already
sleeping when my water broke

at around 3 am.
So next we called the doctor.

So he said he was kinda sleepy
because it was 3 in the morning

and he asked: ''What time is it?''
l replied: ''3 am.''

''No, Amanda, you gotta wait now.''
Good, then.

Five minutes later he called me.
l'm not kidding,

l think it was 5 minutes and
he said: ''No, Amanda,

go to the hospital because
l have to check on you,

we will feel your dilation,
see it right, the color of the fluid

that is draining out...''
And everything was fine, right,

l told him about the color of
the fluid, and he said:

''lt's normal, but head to the
hospital let's take a look.

When you arrive there, you will be
checked by a colleague

and then l'll arrive. lf that's the
case, we will have to perform

a C-section.'' l arrived,
she did a vaginal exam

and l was 1 cm dilated. My doctor
arrived right away and said so:

''Oh, Amanda, this can be very
harmful for your baby,

because until you pass through
all the dilation process,

it can take long and can lead
to fetal distress.''

l got scared, you see,
l said,

l'm not going to let that happen.
Do what you gotta do.

EVlDENCE-BASED MEDlClNE

ln theory there should be a bridge
over which the produced

scientific knowledge from one
side to the obstetric practice

on the other side would pass.
Unfortunately,

this bridge is broken
in many circumstances.

Contrary to what many lay people
think, for a long period of time,

medical practice was not supported
by solid scientific evidence.

When we started talking about
evidence-based medicine,

there were people,
especially health providers,

who were shocked:
''but how is that possible?

How come medicine is not based
on evidence?

lsn't medicine a scientific activity?''

lndeed, most clinical practice,
until recently,

was not endorsed by solid
scientific evidence, unfortunately.

Some researchers realized that
childbirth care

was based on guessing,
on medical dogma.

Then they questioned that,
started to investigate

and to compare birth outcomes
with or without episiotomy,

with or without Pitocin,
for instance.

And it dawned on them that most
procedures were harmful and painful,

and shouldn't be
routinely performed.

lt's tragic. Many health professionals
didn't have access

to this knowledge.
Many medical school professors

do not update their teachings
according to scientific evidences.

There is that common speech:
''l've been delivering babies

for 30 years, l've always performed
episiotomy and have never had

any problem. lt's not now
that l'm going to change.''

So it's very difficult to go against
this authoritative speech.

lf the doctor said so, then... ''Geez,
who knows better than the doctor?''

RlTUALlSTlC lNTERVENTlONS

Human birth merges together the
three most feared events to mankind:

life, death and sexuality.

lt's exactly for that reason that
we feel the need to ritualize,

creating in ourselves,
health professionals,

the delusion that we
have control over birth.

That's why we resort to numerous
ritualistic interventions

that bear no connection
with scientific evidence

when attending pregnant
women in hospitals.

Women are obliged to give birth
in the conventional dorsal position,

must lie down during labor and
suffer unnecessary interventions.

And during birth itself,
apart from several aggressive,

inadequate and unnecessary
verbal orders,

there are also other interventions
such as episiotomy

and Kristeller maneuver.

lt is calculated that no more
than 1 5�/� of women

present health or birth dynamics
problems to require

some sort of intervention,
nevertheless we are close

to 1 00�/� intervention. And it is
not possible that 1 00�/� of women

may have a defect or problems
that prevent them

from giving birth naturally. ''Our
bodies were not made for that?''

My water broke at home,
but during birth,

the OB climbed upon my stomach
along with the pediatrician,

right, to help me... The pediatrician
was trying to push,

MOTHER AND HOUSEWlFE
telling me to push my daughter out
and the other doctor was over me,

and they cut me down here,
so l could deliver the baby.

Contemporary society frequently
produces the poison,

and then sells the antidote. That's
clearly what happened to childbirth.

And then people have this
collective fantasy

that it was either the mother's
or the baby's fault,

or even the childbirth itself
was to be blamed.

The problem was never caused
by those unnecessary interventions.

So the idea is that hospital staff
saved all these people.

Actually, these unnecessary
interventions performed

in hospital's routine have created
all those subsequent problems.

Sometimes it works like a cascade
of inadequate procedures,

not only one isolated event.
For every procedure

there is not only its inherent risk
but also the need

of additional interventions in order
to fix what the first has caused.

Women are not asked for permission
for all the procedures

that are made on their bodies.

They sometimes suffer
very aggressive interventions.

lt's a dilemma that we must
solve by searching

for another childbirth model
of care, a natural birth indeed,

in which physiology should be
respected, in which interventions

would be performed under
strict indication only.

A newborn is like wet cement
and everything that they feel

and their every sensation
is amplified.

So, when a child is born at a cozy
home and is immediately placed

in the warm arms of her parents,
you know, and

experiences skin-to-skin contact...
the message she receives is:

''it is worth being born, this world
feels like a receptive one,

it is a warm world.
lf she is born and separated

from her father and mother, it is
a beginning marked by the need

for survival which
is very hard on them.

The classical hospital childbirth
is very violent.

There is the dispassionate
handling of the baby,

PERlNATAL PSYCHOLOGY
stretching that little shrunken body,
all the noise and the lights around.

lt is such a great shock that the
first strong transition of their lives

is marked by violence.

l remember when Pedro
was born, that the girl

who was going to bathe him picked
him up as if he were a chicken,

by his leg and l said:
''Cut it, cut it out! Cut it out!''

and she replied: ''take it easy,
l do it every day''. Then l said:

''But he has never. l don't care
if you do this twenty times a day,

my son has just been born,
and he is mine and unique.

He has never been grabbed like
a chicken by his feet

or anywhere else because he was
in a bag of water, so let me do it.''

As pediatricians, many of us were
trained as routine procedure

to suction the baby's mouth so
they can breathe more easily

as soon as they are born.
lf any of us, at an adult age,

are subject to mouth suction,
we will vomit,

it will be painful and we will
possibly feel discomfort

if we need to eat anything
right after. Nevertheless,

we are trained to do this
to all newborn.

When it is an unnecessary procedure,
babies may perceive this

as an intense aggression
at their birth.

A lot of dreadful mistakes
that we see,

but the kid comes out alive,
so everybody...

and it seems that the doctor
performed a miracle.

Sorry, folks, the woman was
the one who gave birth,

and God is backing her up.

SURVlVlNG lSN'T ENOUGH

Unlike everyone's belief, birth
will mark the child's life, right?

He was born naturally? What
difference does it make?'' they ask.

ln fact, it makes a
huge difference.

The idea is not the baby
surviving being born

and the mother surviving childbirth.
Our goal is the quality involved.

The idea is to have tenderness
during every aspect,

in every moment of labor
and childbirth and during

the baby's first hours of life.
We don't want survivors.

We want well-received people,
and respect all the time.

lt is more like handcraft,
you know?

You just don't take your wife
into something

that's sort of delivery mass
production, in which your child

is going to be born on a day
that's suitable in the agenda.

They will give you an excuse,
he will be born,

you will take him home
and you'll be happy.

But the fact is that the child
who had the opportunity

of a natural childbirth
will have benefits.

What l find very funny
in the whole process

is the rationale behind of what
people think, even family:

''but they were born well, healthy,
doctors fulfilled their roles

bringing them healthy.''
And l replied:

''No, it was l who brought
her healthy.'' l mean,

l am very grateful for the doctors,
but l think the story could be

much more beautiful, everything
could have been much richer

for me as a woman,
for me as a mother, isn't it?

So yeah, frustrating,
very frustrating.

l still want to cry.
lt's not right!

What l've been through
doesn't feel right

and other mothers had
the same experience.

lt should've been a very beautiful,
a very different moment

from what it really was.
l feel sorrow,

l'm angry and l'm even afraid of how
my next pregnancy is going to be.

Right after Pedro was born,
l started studying, right?

l should have studied before.
Then l started studying

the history of childbirth and l said,
hey, so now l will give birth

to Nina naturally. But the problem,
l mean, the doctors said

that the C-section had been
very recent. l know that nowadays

it is a common strategy,
let's put it this way:

''once a C-section,
always a C-section.'' And l said:

''l'm not going through my whole
life without giving birth naturally.

l can't deprive myself
of having that experience!''

And it was great, it was great,
it was this overwhelming experience,

and then Nina came.
l was in labor for 1 2 hours,

it was an amazing experience and l
felt l could leave this world happily,

because l gave birth naturally.
l felt like l did it along with Nina.

lt was our thing.

LABOR AND DELlVERY

First and foremost, going into
natural labor means that the baby

is ready to be born.

But what exactly makes a baby
be born on the 4th or on the 28th

or on the 1 0th? We don't know.
But when it happens at term,

that's the best choice that
the baby herself made.

That's where the importance
of labor lies.

During labor, several
physiological changes occur,

which provide the baby with better
adaptation as soon as she is born.

Evidence shows that labor
triggers hormonal discharges

which help the baby mature and
which send her messages telling her:

''it's time to be born,
get your systems ready''.

A child that is born after labor,
even by C-section,

will be under better conditions than
those one who were taken out

of the uterus during sleep.
They were there,

sleeping like babies, literally,
inside the womb, and suddenly

you pull them out and say:
''You're outside now.''

So we are talking about
short-term benefits,

but there are several other
long-term ones

that will last during the
baby's entire life,

when she is already an infant
and when she further develops.

Labor plays a fundamental
role in birth.

Regarding safety, which is obviously
a very important concern

to the mother,
labor is much safer.

lt involves respecting physiological
birth conditions,

in spite of other varieties,
such as: ''Be here tomorrow at 4,

check in and your baby will
be born at 5.''

However, we haven't agreed
with the baby.

When l decided to be a mother,
l also decided what kind

of birth l wanted. l wanted a
natural childbirth experience.

lt was not at all easy as it took
8 hours and the pain was intense.

MOTHER AND BUSlNESSWOMAN
The way we conducted my labor
didn't make me think

about giving up birth at all. We
used palliative pain management

during the process, such as
acupuncture, massage.

l spent the whole labor along
with my doula and my husband only,

which was fundamental.
We dimmed the lights,

we listened to music, l managed
to concentrate myself

on what l was doing. l had this
strong connection with my body.

ln the end l found everything
was very beautiful.

l think natural childbirth is
great poetry, it is very poetic

when you allow your instinct and
your body to work on its behalf.

When a woman experiences uterine
contractions and receives the

''hormonal cocktail'', establishing
the bond with the newborn

is much easier. Women recover
physically much faster

from a natural childbirth,
they bleed less,

so anemia is unlikely,
and there is less risk of infection.

Even high-risk pregnancy,
in general,

will benefit from normal birth.

When l pictured myself pregnant...
l have three girls.

l've always wanted to be a mother,
have always considered normal birth.

l had this instinct that this would be
better and much more pleasant

and that it would complete me.
Before birth,

OB-GYN
it was kind of a challenge too,
because l heard in the hospital

l worked for that it had been 1 0 years
since a physician gave birth naturally.

That was another bit
of a challenge for me:

''So, now you are all going to see
a doctor giving birth''.

Of course l felt very
powerful afterwards.

That's very interesting because
today l am an OB-Gyn,

so l'm a role model for my patients;
l lead by example, right?

So it's like: Do as l say,
but l did it too.

l really believe in
what l'm offering them.

LABOR PAlN

For us, women from western
Judeo-Christian civilization,

that biblical saying ''with pain
will you give birth to children'',

there's a great impact.
lt is as if becoming a mother

were intrinsically connected
to suffering.

And the media such as TV and the
movies contribute to enhance this idea,

showing women in labor groaning
and writhing in pain.

Of course most women will really
experience pain during labor,

but testimonies reveal that most
of the complaints are about

the emotional abuse they've suffered
and about unnecessary interventions,

not about childbirth itself.

Childbirth is like
mountain climbing.

You have to carry a backpack.

Prenatal care is packing;
it is the preparation

of what you should be
taking with you.

lt's the assurance of a low risk
pregnancy and that everything is fine.

Probably, when you reach half the
way, almost at the end of the hiking,

you will get cramps and think you
can not take it any longer

and that you'll have to stop.
Then you stop, breathe and think:

''Wait a minute! lf l was able to get
to this point, l can go further.''

That's the beauty of it! lt's the
possibility of transcending limits,

no matter what they are:
tiredness, pain, sleepiness,

hunger, it's the willingness
to solve it all.

So you connect with your
inner self and say:

''No, come on, l can handle it!''
Then you go ahead.

And when you get to the top of
the mountain and see the view,

you'll understand that it is totally
different from getting there

by helicopter.
You did it yourself.

Pain and suffering are not
related at all.

This is something very important.

The possible painful uterine
contraction during labor

lasts one minute.
After one minute,

you'll have 3 minutes, 4 minutes,
5 minutes of total relaxation.

There are women that fall
asleep between contractions.

Birth is not only a physiological
act that begins

with the uterine contractions
and ends with the baby

and the placenta being born.
After all,

birth is a true rite of passage
not only for the mother,

but also for the entire family
and for the baby,

who has an active role
in this experience,

and comes out stronger from it.

People think that childbearing
is exclusively a body experience.

A process of a baby descending
through the birth canal

and coming out.
Just the physical aspect.

But l've spent many years
attending births

and l see that birth is her soul
expressing itself through her body.

Given the right conditions,
birth can be

the most transcendental moment in
the life of a woman and her family,

from all points of view: physical,
emotional, spiritual, sexual...

lf l could give birth, l would.
Why would a mother give up

on her so special and magical
moment and be sedated?

There is a complete lack
of common sense in the world,

as if the people were going to
consume, consume, consume.

lt is such nonsense that
we use drugs,

we go to amusement parks to feel
some intensity, isn't it?

Or when we go through
a tragic moment

we can feel life is strong.

But it is about a moment in
our lives that is not tragic,

it's a gift.

We celebrate weddings
that won't last a year,

we sometimes spend a fortune
and take years to prepare ourselves

for some artificial and so
meaningless events!

And labor and birth alone naturally
provide us a situation

that empowers,

fortifies, feeds us, shapes us.

So when l see that we have 52�/�
of C-sections in Brazil,

l look and l say: ''We have
been losing opportunities.''

HUMANlZED LABOR AND DELlVERY

Doulas are birth attendants,
but they are trained ones.

They don't perform medical
nor midwifery procedures,

they don't replace the partner,
they have another kind of look.

They have a professional look
over childbirth,

even without performing procedures.
During prenatal care,

they help women make
their birth plan, they inform

and show sources of good
evidence-based information

so that these women may research
and write their own birth plan.

When we don't separate mother
and baby and let them look

into each other's eyes... lt is
the most powerful antidote

against any kind of baby blues
or postpartum depression.

Why do we separate a baby
from her mother at birth?

The baby came from inside the
mother's body, under 95 or 96 �F,

and she shouldn't be received
at 64,4 �F or 68 �F,

the temperature inside an OR.

The baby should be received in
a warm and dark environment,

with the least possible sensory
stimuli. Stimuli attack the baby.

And l can check everything l need,
for instance,

check Apgar score when she is
still in mother's arms.

l don't need to give her a bath,
l don't need to remove vernix,

which is very important
for her protection.

That is true also for a birth scenario
when the baby is not fully adapted,

because she is premature or
when there are breathing problems.

The more l delay chord clamping
and separate her from her mother,

the better.

That's a major challenge for us all.

We will only truly humanize
childbirth if we return

We will only truly humanize
childbirth if we return

to women full over their
destiny and birth.

The three fundamental pillars of birth
humanization therefore are:

firstly, handing protagonism
back to women,

which is fundamental;
secondly, provide a broader,

integrative view of the phenomenon,
not merely from

a mechanical and physiological
point-of-view

but also including psychological,
affective, emotional, spiritual,

cultural and in context with
where the birth is to take place.

And last but not least, a profound
bond with evidence-based medicine.

Everything that is nowadays said
about humanizing childbirth

is based on the most modern research
on labor and childbirth procedures.

ln Brazil, most births, around 90�/�,
are attended by doctors.

There is evidence that births can be
attended by other professionals.

This is the standard model of care
in many other countries.

The World Health Organization
considers the following

as licensed professionals
to attend births: OB/GYNs,

family doctors, nurse-midwives and
certified professional midwives.

Those attending births in hospitals
who are called ''parteiras'', they are

in fact, nurse-midwives or certified
professional midwives (CPMs).

The latter are new to the
Brazilian market.

This model that we have
in Brazil to certify the CPMs,

it is based on an
international model.

lt is based on the risk assessment
throughout pregnancy.

Every prenatal appointment we
assess anything

that can be considered
out of the ordinary.

lf she has anything abnormal
show up at any moment,

l must have her referred

so she can have more
specialized healthcare.

As long as she remains low-risk,
l can continue her care.

What is the evidence available?

There is also this systematic
review published in 2008

which shows that midwife-led
models of care

have several advantages

over the traditional
medical-led models

for low-risk mothers.

We dream of being able
to comprehend this

and especially understand that
in the Brazilian scene,

we have room for everybody.

What we don't have room is for
a completely medicalized birth,

that doesn't treat the mother
as an individual

and only involves protocols,
as if protocols

could handle peculiar situations,
so delicate and unique

as the birth process.

Nowadays, most births happen
in hospitals and we know that

for a low risk birth, the hospital
environment is not conducive

to having the mother
feel competent

and feeling capable
at that moment.

lt's not just about having
a vaginal childbirth.

l have assisted so many deliveries
where women gave birth

in extraordinary ways. lf she
needs to walk like a beast,

around a tree like this,
to enter this birth energy,

she must do it, she must be given
the possibility.

lf she needs 3 days to give birth,
my God, she must have those 3 days.

And the most adequate place
for a woman to give birth,

according to the
World Health Organization,

is a place where she feels safe.

Some women will feel safer
in the warmth of their homes.

Others will prefer to have
their babies in birth centers,

in their neighborhoods,
nearby people they know.

Some other women will choose
to give birth in hospitals

because there is where they feel
safest, closer to technology.

The health system should offer
all these alternatives to women,

so that they can adapt themselves
to what they feel is best.

When l got pregnant with Felipe,
l said, hey, l had a C-section,

a hospital birth,
now this is what l need;

l am going to birth Felipe
at home.

And then it was like this,
widespread concern.

But after seeing and understanding
and studying,

especially because l only agreed
to it after having understood

and after having had access
to literature, not the literature

that there is nowadays,
the kind of literature that we buy,

imposed on you and written
to speak evil about it.

lt was so cool.
We stayed in bed,

in our room, watching movies,
massaging, such a great energy.

Then we took a walk around here
in the living room

because the pains were coming,
it is something

that you have to go through
but l don't regret it,

l would do it all over again!
And it happened at night,

the house was in silence,
it was good,

we were in peace and then finally
Felipinho decided to come out.

And l could realize that it was
much simpler than anything else.

As simple as that, my son
was born in my hands,

the water didn't break, he was
born in the caul, right, l opened it.

Oh, it was so...

it even makes me want to have
another one, you know?

lt was such a beautiful experience
and the coolest part of all

was that Felipinho came
directly to my chest,

and remained there nursing
for two hours.

And in the morning my kids
got there and

''Can we visit Felipe?
ls Felipe already there?''

And they entered our room,
and the kid was on our bed.

lt was incredible!
And l remember

when l was in the maternity hospital
walking back and forth

without having any access,
or when l did,

l could only see... whatever!

Nothing compares to the emotion
of you being able

to live this moment as it should be,
with touch, with her,

with her warmth, with her voice,
with all the suffering that comes,

because it is not easy for the woman
to really go through that

without anesthesia,
but what Andrea earned

after having gone through that,
just as everyone

l believe goes through such
a moment, earns a lot.

l felt very capable,
l felt strong, you know?

A lioness, a mother who did
her best for her son.

Planned homebirths
exist worldwide.

We have it in Holland,
we have it in England, in Japan,

Canada, Australia, New Zealand,
there are different homebirth models.

ln Brazil, there are two homebirth
models that coexist in different ways.

One of them is the traditional
midwife model

in North and Northeast Brazil,
which exists in great quantity.

Very often, that woman doesn't
have access to health care services,

which is a paradox:
sometimes they need a C-section

and they don't have access to
it because it might take two days

to get there by boat.

l started catching babies
in the rural area.

There were times l would even
go by donkey or horse.

TRADlTlONAL MlDWlFE
Women would call me and
l would go.

l delivered my sisters too,
helped my mother.

When the TBA arrived, l was catching
my sister and then l started.

l already delivered in a carriage,
on the ground,

l already delivered in a carriage,
on the ground,

in the bush, under a tree,
on a banana leaf.

There was a hospital,
but their conditions were harsh

to get to the hospital.
Because for us,

who live in rural areas,
we don't have a car,

there's no way to get to the hospital,
so they preferred to call the TBA

to have their babies at home.

PLANNED HOME BlRTH

And there is another movement,
which is growing a lot,

which is homebirth in
urban centers.

Homebirth can be assisted by a
nurse-midwife or a certified midwife,

or in some cases, even by doctors
who work according to this model.

Homebirth is for a low-risk woman,
a woman who didn't have

any complication during pregnancy.
We go well-equipped,

with a set of materials for attending
a birth in normal conditions

such as gloves, gauze, things that
we are going to need to assist;

and also for more
complex situations.

So if l need to give stitches,
l have stitching thread,

l can apply local anesthesia,

l can use some kind of medication
for hemorrhage,

l have things at my disposal.

l have oxygen if the baby needs it,
all neonatal material for resuscitation.

l have a trunk full of things to give
assistance to the woman.

What we have today at our disposal,
for us to understand homebirths,

are retrospective studies,
in which we study a group of women

who have already gave birth
at home or in a hospital;

and prospective studies,
in which we study a group of women

that will have a baby at home
or in a hospital,

and then compare results.
And there so many studies

conducted abroad with
a huge number of women,

which tells that homebirth is pretty
safe, as safe as a hospital birth.

A Dutch study published in 2009
with more than 500 thousand

childbirths demonstrates the
safety of planned home birth,

in terms of perinatal outcomes
very similar to those

in low-risk planned
hospital birth and

with much reduced number
of medical interventions.

ln a domestic environment,
for instance,

there are all bacteria from that
environment which are favorable

to mothers.
They are mother's friends.

One would never have an infection
in a domestic environment

as one would in a hospital.

ln health care scenario,
there is the possibility

of anticipating any event in
the point of view of prevention.

Trained care providers,
such as the midwife,

nurse-midwife or even a doctor,

are able to gather information

and decide whether it can be
a homebirth or not.

What in fact makes difference
is prenatal care to identify risks

because risks also exist
inside the hospital.

When we think in terms
of home birth,

it is not that the baby will have
to be born at home

because she planned it that way.

The woman in labor stays
at home as long as everything

is going according to plan and
everything is absolutely normal.

lf we suspect that maybe there's
something not normal,

we head to the hospital and the
birth will end at the hospital.

And most of them still end up
being a normal birth,

but with some intervention that
we cannot perform at home,

because each intervention
adds risk to childbirth.

Every woman will feel safer in
a different environment

and many times the place
she will feel safer is a hospital.

Therefore we know that homebirth
is maybe for a small share

of the population. Our minds
still work very attached

to the hospital model of care.
l think that most important

that all women can choose to have
a homebirth is that they understand:

''Wait a minute! lt can happen at home,
it's not that complicated after all.''

SOLUTlONS

There is a set of initiatives that
can improve the scenario.

Everything that happens in the
capitalist world is determined

by consumer demand.
This nice childbirth

is also going to happen due
to women demand.

We have to improve the quality
of information for women

using simple language,
in simple leaflets,

so that they arrive at the
hospital and say:

''Don't cut me, don't cut me
because l know what l'm losing.

l don't want to be cut,
l don't want to be hooked up

to an l.V.,
l don't want Pitocin.

Let's teach everything about
childbirth to those who are

1 4, 1 5, 1 3 years old, the same
way they study Geography,

History, Grammar, Childbirth! That
is way more than sexual education,

that is education for life! Why?
Because then when the time

comes to be pregnant,
to give birth,

there's already a very rich theoretical
foundation that is part of that woman.

lf you only offer her a bad option
for birth, full of interventions,

violent, lying on her back,
with her legs spread apart,

or a scheduled C-section,
she has no option,

she has no choice.
Yet, if she can choose everything

concerning her birth,
the birth of her son,

then you have a wide range
of options.

lf she is aware of her decisions,
she will have a good birth,

regardless of her choices,
she will have a good birth.

Practioners must recognize that
they have an ethical commitment

to doing good, and should
abandon what is harmful

and ineffective.

Health system managers must have
the courage to take measures

that are unpopular with
health professionals

and take control of
C-section indications.

As long as childbirth care
is controlled by doctors,

it will be very hard for us to
reduce the C-section rate;

the insertion of new
players is urgent.

Playing with nature,
in the way we have been with

too frequent interventions generates
much more morbidity

than solutions to problems.
We know what we are doing today

with the human birth is in many
instances an aggression

to the building process of the human
birth, more than 7 million years old,

and can put our own survival
on this planet at risk.

When there isn't any woman
giving birth vaginally,

due to our society's absolute
incompetence in dealing

with this phenomenon,
it may be too late.

We've had earlier experience
of weakening, collapsing societies

that did not know how to deal with
the ecological challenges

they were submitted to.

l hope society is not going towards
a path of no-return.

What will it be of our love
hormone production system

if it stops being used
and starts being useless?

What does that mean
in terms of civilization?

l made up my mind:
''my next daughter will be born

the most natural way possible.''
''That would not happen again.''

l sought for information.
l found a wonderful doctor,

an amazing doula and my family who,
in spite of not accepting my idea,

respected me. And the birth
was marvelous, peaceful, at home,

in the dawn. Rafaela was
born in the shower, this shower.

Birds were singing...
She was born

and came straight to where
she should be: my breast...

and she didn't leave until she fell
asleep and went to her father's arms.

l have never had such a feeling
in my whole life!