Original subtitles

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!