Original subtitles

Becoming a mother was my first concern.

How she'd be born didn't really matter.

I wanted her to be healthy.

I prepared myself for a natural birth

doing yoga and talking to people who had already had a normal birth.

But today I'm aware I didn't have any knowledge

of the physiology of natural birth,

its importance for the baby and the mother.

MOTHER AND BIOLOGIST

I didn't care about it.

What I cared about was my anxiety and the doctor's opinion,

who cared more about his time, that was more valuable

than my daughter's life.

When I went to the doctor, with the report of a cord loop,

he said: "She has an umbilical cord loop around her neck

and that may kill your baby."

When a mother hears that,

if she isn't prepared,

and has never heard about it,

she says to the doctor: "What do I do?"

and he said: "Let's schedule a C-section to prevent it."

I was 38 weeks and two days pregnant

and it was scheduled for the next day.

Everything went just fine, my recovery was nice,

the baby's APGAR was good.

So, to me, it had been a perfect delivery.

My daughter was fine.

When I got pregnant with my second daughter,

she was three years old,

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

And I played the video from the day she was born.

And we were both shocked, though I had seen the video before.

But that moment touched me because she kept asking:

"Mom, why am I alone? I was born and there's nobody with me."

She was, as she said it herself, abandoned.

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

"You left me alone, mom. Why? I was in your belly and now I'm alone.

Where are you, mom? Where's dad?"

I saw my daughter come out of me, the way she was taken out,

being shown very quickly to me by a pediatrician

who didn't let her come close to me.

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

After watching the video I could see the way they had treated her.

Going through several procedures that I consider highly unnecessary.

It was cold, there was a bright light in her eyes.

She was crying.

Besides being brutally taken out,

she had to endure all that in her first minute.

Then, I made up my mind:

"My next daughter will be born the most natural way possible.

This is not going to happen again."

And I sought for information

to know why,

and what I could do, so that my child could be born well,

and I found it.

BIRTH REBORN

A FILM BY ERICA 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'll desire to have a child.

So this subject is related to the whole society.

DOCTOR AND RESEARCHER

There are stories that child births in pre-agricultural civilizations

were much simpler and faster.

The way childbirth is assisted

in contemporary industrialized societies

is a quite new event

if we take into consideration the time we have been on Earth.

Childbirth was something absolutely of women among women.

From that time on, we've had several changes.

We've had great technological breakthroughs,

the entrance of the doctor in the childbirth scenario

and, of course, when we place women inside a hospital,

two other things come historically:

horizontal delivery and episiotomy.

EPISIOTOMY

When men got into the sacred and hidden universe of birth

ended up bringing along, with the lights of reasoning,

a shift in the models and paradigms of childbirth care.

Not long ago, the majority of babies were delivered at home,

attended by people from the community and by women.

Of course, back then…

OBSTETRIC NURSE

…if there was a problem, mother and baby'd die.

But not anymore, because we can combine what science has acquired

and what popular knowledge brings us.

Women started going to a place specifically built to assist sick people…

SURGERY CENTER

…such as a hospital, only 40 to 50 years ago.

Therefore, it's very violent the transformation…

OBSTETRICIAN

…from an affectionate family event

with people known to the woman, where she exerted a certain control,

to an absolutely strange, inhospitable place,

with complete strangers to her everyday life

and full of machines.

Thus, quite a scary place for most women.

It is no wonder that many women, upon arrival to the hospital,

start presenting problems, which will subsequently be treated

with more technology added by the doctors.

CURRENT REALITY

ANTHROPOLOGIST

When women migrated to the hospitals to have their children,

they lost their power over birth to the doctors.

Women ended up settling to rigid patterns of the medical system

of delivering within a number of hours, and behaving 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 were molded in the birth process

in a very subtle way.

VITAMIN C

OXYTOCIN

We can't give birth like our mothers used to.

My mother and my grandmother had three normal deliveries.

Anyway, we ask ourselves…

MOTHER AND PUBLIC MANAGER

…what is happening with our bodies, with our history?

That we can't do anymore what should be normal,

what other mammals, other animals do.

The childbirth care model in Brazil,

highly technology-oriented,

has slowly created the culture of cesareans

as the most comfortable way of birth…

MANAGER OF THE MINISTRY OF HEALTH

…perhaps more suitable to this consumer society.

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

That's a fact.

Today, childbirth in Brazil has become a surgical procedure

instead of a physiological event.

Everyone sees delivery as a surgery…

OBSTETRICIAN

…the doctor, the patient, the hospital.

The Brazilian health system is ineffective, right?

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

In regard to pregnant patients, it is increasingly true.

Nowadays, with prenatal appointments lasting 15 minutes,

you can't even clarify your doubts.

In 15 minutes you lie down,

get your blood pressure checked and listen to your baby.

But how can a doctor afford to keep his office open

with a 15-dollar fee?

We are all taxpayers and we are paying…

EPIDEMIOLOGIST

…for an assistance which is either inappropriate

or endangers the lives of women and babies.

Nowadays, our cesarean rate, to our sorrow, has exceeded 50%.

We have a 52% cesarean rate in Brazil.

There is a cultural and economical logic to this.

There's a reason for that.

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

less risky, that it does not carry any risks,

that it will save the baby.

The doctor, despite having learned that vaginal birth is safe,

good for the mother and baby,

ends up believing in some of this false truth

that a C-section is safer.

THE INDUSTRY OF BIRTH

I was very young. I was 22, 23 years old.

And I wasn't aware of this world of C-sections.

I thought it was possible to have a normal birth.

MOTHER AND NUTRITIONIST

The doctor led me to believe that until the end of pregnancy.

"You'll have a normal birth, don't worry, everything is OK."

And suddenly she said that Pedro had the cord around his neck.

And that Pedro, therefore, had to be born via C-section.

I was very young. I truly believed her,

but there was something in my unconscious

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

But who would switch doctors at 38-39 weeks?

What if a problem occurs? And the whole family saying:

"You must give birth now." And I had the C-section.

Sure, it's business! For the doctor, it's much better to perform a C-section.

FATHER AND ACTOR

Of course there are exceptions, there are people with more common sense

to allow a normal birth.

But most of them push for a C-section.

The time spent attending birth

doesn't fit the time schedule of many doctors.

The amount paid isn't worth canceling your private office appointments.

You earn more there than attending one birth.

And we can't hide reality.

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

We see a lot more NICU admissions the day before major holidays…

PEDIATRICIAN

…because on those dates C-sections are performed more frequently.

Obviously doctors want to spend the holiday without the risk

of leaving home to attend a birth.

But that's part of our choice.

We chose this specialty.

When interviewed, postpartum women often believe…

OBSTETRICIAN

…there was a medical indication for their C-sections.

When we interview doctors,

they blame their C-sections on the women's decision.

They are sometimes in their first pregnancy

and get slaughtered in a cesarean,

without the slightest mercy or pity.

First I had no intention of doing a normal birth.

I was afraid, but I started to find that normal birth was the best.

MOTHER AND ACCOUNTANT

I did a lot of research on the internet, talked to friends.

Then, friends referred me to their doctors.

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

They tried to persuade me into a C-section.

I would go and say: "Doc, tell me about natural childbirth."

And he said:

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

He said nowadays C-sections are quick, you go home, recover,

and there is no problem, that was one doctor.

I still had three appointments with him,

but he always scared me

and my desire for a normal birth increased.

Now, think from the hospital perspective. What do you prefer?

A patient, a pregnant woman,

who will deliver a baby without spending anything.

She will just pay for her hospital stay.

In a natural birth what do you spend?

Compress, gauze, nothing else.

For the hospital it is more interesting to get that scheduled patient.

They can count how many patients there will be during that day.

The OR moves more smoothly and neatly.

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

For 12 hours that room cannot be used

because there's a woman who wants to give birth.

It is a multifactorial problem, there isn't a character…

OBSTETRIC

…who's the big bad wolf of the story.

There are interests that intertwine.

But we hear a lot that women ask for C-sections,

and there are two aspects:

First, if a woman thinks her option is that horrendous birth,

where she is abandoned and has no privacy,

there's cutting and pain, she asks for a cesarean.

Secondly, if the woman who asks for the C-section exists.

She's minority in Brazil.

There is research on that.

Potter's works, in collaboration with Professor Faundes, have shown

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

Most women get pregnant and say: "I want a normal birth".

As prenatal care continues, she changes her mind.

And sometimes things are very subtle, like: "What a big baby!"

"Right? Will it pass?"

"It's hard, such a big baby."

And the woman loses confidence.

"Oh, you want a normal birth! Congratulations, because it hurts a lot!"

"It's very difficult, you are brave."

That kind of subliminal message

that normal birth is difficult, painful,

a super difficult challenge to overcome, undermines her confidence.

She then says: "It's true, am I ready for that?"

FETAL EVALUATION

Three weeks before my due date, he said that

though she was well-positioned, she was too large.

He prescribed an ultrasound, and referred me to a doctor.

We saw my baby moving. Everything was fine.

Then we saw a frozen image

with a baby with the cord around his neck.

We realized it wasn't our daughter.

We said something to the doctor, showing our distrust…

MOTHER AND TEACHER

…and he changed the subject.

We went to another clinic, to a doctor we trusted,

who attended my first birth, my first pregnancy.

I did an ultrasound 30 minutes later and didn't see a cord around her neck.

That day I returned to my doctor's office

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

"You didn't go to the doctor I recommended?"

I said: "No, went to this doctor, whom I trust."

He said: "The thing is your baby is big.

It can't be a normal birth. You'll need a C-section."

I said: "Doctor, can't I wait, you know, for contractions,

any sign that she is ready to be born?"

He said: "No, we can schedule. I have a free day, Wednesday,

if you schedule a C-section, I'll do it.

Otherwise, you can find another doctor".

For surgeons, it's the scalpel curse.

It is a very easy solution.

You must have philosophical principles

and very strong convictions

not to give in to this temptation.

Some private health insurances

pay only $60 for a doctor to attend a birth.

Sixty dollars!

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

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

from dusk till dawn.

I guess it's the only specialty where you have two lives in your hands.

The hospital offers no kind of support

no physical structure.

Comes a point when you get tired.

Many doctors start doing vaginal births.

At first they fight but get lost as time goes by.

If you don't have very strong convictions,

that creates a dissatisfaction, and you say: "I won't do it anymore".

MYTHS

Many myths have been created about the risks.

As a protective mother, you want to minimize them.

"Do you want bigger risks for your baby?"

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

Understand what are in fact the risks.

Prenatal myths are numerous.

We find them in beauty salon chats.

"My neighbor's cousin."

"She 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 give birth,

and by old I mean she is over 30, 35.

Or she is too young to give birth,

too fat or too skinny to give birth,

sedentary, or her vagina will become loose.

That it hurts a lot, that if you have high blood pressure

or diabetes you can't give birth.

Cord around the neck, baby is too big,

baby is too small, advanced placenta maturity,

too much or little liquid, are all fake indications.

They are ghostly entities created

as cesarean indications.

One of the greatest excuses is

the cord wrapped around the baby's neck.

It's absolutely physiological and around 40% of the babies

are born with a loop of cord around their necks.

But there's the "killing cord" myth.

There isn't any chance of a baby being strangled

by his umbilical cord.

We also hear a lot that the woman didn't go into labor.

That's a lie because all women go into labor.

But if we operate before she does then clearly she won't go into labor.

But if we wait until 42 weeks,

which is the duration of a pregnancy, women will go into labor.

We hear a lot about lack of dilation,

but this is extremely rare.

Most cases referred to as lack of dilation,

there wasn't any respect for its physiology.

Women were admitted to the hospital too early,

not in active labor.

Or even without the labor having started.

It takes patience and waiting,

as dilation won't happen as if by magic.

I remember asking: "ls everything all right with him?"

I told her that once born, I wanted him to come to me.

I wasn't happy with that C-section.

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

And I asked if he was OK and no one answered.

And I was worried because Pedro went somewhere with the pediatrician.

"Is he OK?"

Then she came to me and said:

"Andrea, everything's fine with your son, relax!"

And I said: "OK, everything is fine, but I want him here with me."

I felt so fragile with that rude answer she gave me.

And she was so insensitive in such an important moment.

She didn't respect that. For her, it's just one more.

It's indifferent. 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, without labor.

When it isn't 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 is important, for instance,

to estimate gestational age until 13 weeks.

It is more accurate in this period.

Near the end of pregnancy,

it can miscalculate in plus or minus two weeks.

Some studies point that this error is usually for less.

So, 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

where the way to be born is through a C-section.

And a schedule accommodated C-section.

The consequence is premature babies,

that need to go to the NICU

with all the repercussion of being premature,

of not being birth-ready and forced to be born.

Among lay public the idea is that the C-section saved that baby.

If the baby was born like that by C-section,

imagine if we had waited three weeks for a normal birth!

If there is one really radical thing, that's birth.

It's true, clamping the cord, abstracting from all symbolism,

You are attached to a placenta, which is attached to your mother,

all functioning biologically as one.

And in one second you say: "deal with it",

this is deeply radical,

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

World Health Organization studies

show that C-sections without a defined clinical indication

may cause respiratory complications for the newborn,

increasing his chance of being admitted

into the neonatal ICU and increasing neonatal mortality.

For the mother there's a higher risk of hemorrhage and infections,

let alone long-term complications.

Then one has to look at greater populations,

not ten births but a thousand at least.

And then we will identify that in elective C-sections,

there are more more infections, more weaning,

a more difficult mother-baby bonding.

It's evident that if he's born this way, the baby isn't given to his mother,

she is not allowed to nurse in the OR.

No one waits for the birth to end before all other procedures are done,

it's like an assembly line.

What I want to know is: did we schedule with the baby

to be born Friday 4 PM, and if we did,

did he answer that he is ready to come?

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

When I switched doctors, I had three appointments with him

and I was being put on the backburner.

I always told him I wanted a normal birth

and in one of the visits I was already eight months pregnant,

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

Outraged, I started looking for another doctor,

but I was eight months pregnant,

I need to have my baby, and to have her normally.

One day I felt sick and went to a hospital, to the ER.

And I met this doctor, told him my story,

that I wanted a normal birth, and he said:

"Amanda, you have a good pelvis, we can deliver your baby".

So I had my last prenatal visits with this doctor

and waited for the day to come.

ESSENTIAL FEMALE DEFECTIVENESS

Human birth is an event that has been molded over

five to seven million years of experimentation.

In spite of those million years of improvement

in the contemporary obstetric model, it was fundamental

the idea that women are essentially incompetent,

and unable to handle the birth process by themselves.

We were trained to believe that female's bodies are defective,

that a woman needs interventions to give birth.

That our intervention is always necessary.

Women believe that they're unable to give birth to their children

in a more natural and physiological way

because culture contaminates their self-esteem.

And then, what should've essentially been an empowering process

by giving birth to their children

became 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 can birth,

their brain doesn't get in the way.

The mind of the modern woman does get in the way,

We need to clear ourselves from the mental contamination,

this social idea that the woman will not give birth…

MIDWIFE AND ANTHROPOLOGIST

…that modern woman cannot birth.

This is not true.

We women know how to give birth! And we enjoy giving birth.

I've always been skinny, my hips are narrow.

I used to think I had some defect,

that I'd never be able to give birth until I got pregnant.

I ended up switching OB doctors, because I heard stories…

MOTHER AND GOVERNMENT EMPLOYEE

…that my first doctor'd make up excuses to make C-sections.

After being able to give birth normally

I realized I don't have any defect. I'm part of Nature's perfection.

My daughter was born small because I'm a small woman.

Even there Nature was perfect.

The current childbirth model in Brazil and many countries

is doubtlessly based on pathology.

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

We always try to label the woman.

Either she has high or low blood pressure,

too much or little fluid, gained too much or little weight.

These are minor issues that are created

to show that this woman has a problem.

Hardly does a woman leave any prenatal visit feeling happy and OK.

It is very good to face pregnancy

not as a state of tension, worries

that something might go wrong.

It is "How nice! I am creating life!"

"A gorgeous pregnant woman! How cool! What a blessing!"

An OB who worked for several years in a reference hospital

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

And most pregnancies are healthy,

but the complicated cases make an impression.

If you tell the doctor: "I want a normal birth",

the classic answer is:

"If everything is all right, then you can have a normal birth."

When we say "if everything is all right", we invert it.

You are going to have a normal birth, unless something bad happens.

I was here at home, already sleeping,

when my water broke at 3 AM.

So we called the doctor.

And he was waking up and asked:

"What time is it?" I said: "3 AM."

And he said: "Amanda, you gotta wait now."

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

He said: "Amanda, go to the hospital

because I have to check on your dilation,

let's check everything, the color of the fluid."

And everything was OK.

I told him the color, and he said: "Go to the hospital to check,

when you arrive there, you'll be checked by a colleague.

If that's the case, we'll perform a C-section."

When I got to the hospital, she checked,

and I was just 1 cm dilated.

My doctor arrived right away and said: "This can be very harmful

because until you go through all the dilation process

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

I got scared, and I said: "I won't let that happen."

"Do what you must."

EVIDENCE-BASED MEDICINE

In theory there should be a bridge uniting

scientific knowledge produced by some,

to the obstetric practice carried by others.

Sadly, this bridge is broken in many circumstances.

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

medical practice was not supported by solid scientific evidence.

When we started talking about evidence-based medicine,

some people, especially health providers, were shocked.

"How? Isn't medicine based on evidence?"

"Isn't medicine a scientific activity?"

Actually, most clinical practice until recently

was not endorsed by solid scientific evidence.

Some researchers realized

that childbirth care was based on guessing,

on medical dogma.

Then they questioned that, started to investigate

and to compare births with or without episiotomy and Pitocin.

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

and shouldn't be routinely performed.

It's tragic.

Many health professionals didn't have access to this knowledge.

Many medical school professors didn't update their teachings

according to scientific evidences.

There is that common speech:

"I've been delivering babies for 30 years,

performed episiotomy and never had problems,

I'm not going to change now."

It's very difficult to go against this authoritative speech.

If the doctor said so, who knows better than the doctor?

RITUALISTIC INTERVENTIONS

Human birth merges together

the three most feared events to mankind:

life, death and sexuality.

It's for that reason that we feel the need to ritualize birth,

to have, as health professionals, the delusion of control over it.

That's why we resort to numerous ritualistic non-scientific interventions

when attending births in hospitals.

Women are obliged to give birth in the conventional dorsal position

they must lie down during labor,

and suffer unnecessary interventions.

And during birth itself, apart from several aggressive,

inadequate verbal orders, there are other interventions

such as episiotomy and Kristeller maneuver.

It is estimated that no more than 15% of women

present health or birth dynamics problems to require some sort of intervention.

Nevertheless we are close to 100% intervention.

It isn't possible that 100% of women may have a defect

or problems that prevent them from giving birth naturally.

Weren't our bodies made for this?

My water broke at home, but during birth

the OB climbed upon my stomach along with the pediatrician to help me.

MOTHER AND HOUSEWIFE

The pediatrician pushed, telling me to push harder.

And they cut me down here, so I 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, the baby's, or the delivery's fault.

The problem wasn't caused by the intervention.

So the idea is that hospital saved all these people

when the hospital practices created all those subsequent problems.

Sometimes it works like a cascade of inadequate procedures.

For every procedure you have its inherent risk

and also the risk of needing additional interventions

in order to fix what the first one has caused.

Women are not asked for permission for all the procedures

that are made on their bodies.

They sometimes suffer interventions

that are very aggressive.

It's a dilemma that we must solve by searching

for another model of childbirth 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, if he is born at a cozy home,

in the warm arms of his parents, with skin-to-skin contact,

the message he receives is "it's worth being born",

this world is warming and receptive.

But if he is born and separated from his parents,

it is a beginning marked by the need

for survival which is very hard on them.

The classical hospital childbirth is very violent.

The cold, the handling of the baby…

PERINATAL PSYCHOLOGIST

…stretching that little shrunken body.

The noise, the light.

It is a great shock that the first transition of their lives

is marked by violence.

When Pedro was born, at bath time,

the nurse picked him up like a chicken. I said: "Stop!"

She said: "I do it every day!" I said: "But he doesn't."

I don't care if you always do this, my son is a newborn, and he's unique.

He has never been grabbed like a chicken! So let me do it."

As pediatricians, many of us were trained

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

But if any of us, at an adult age,

go through mouth suction, we will vomit, it'll hurt,

and we will feel discomfort to eat anything afterwards.

And we are trained to do this to all newborn.

When it is unnecessary, babies may perceive this

as an intense aggression at their birth.

We see lots of dreadful mistakes,

but the kid is alive, so everybody…

The doctor worked a miracle.

Sorry, the woman gave birth, and God was backing her up.

SURVIVING IS NOT ENOUGH…

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

"What difference does it make?" In fact, it makes a huge difference.

The idea is not the baby surviving being born

and the mother the childbirth.

It's about quality.

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 and respect people.

It is more like handcraft, you know?

You just don't take your wife to a mass production of deliveries

where they schedule your son.

He will be born, you'll take him home and you'll be happy.

But the fact is that the child who had the opportunity

by natural childbirth will have benefits.

What I find very funny in the whole process

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

"But they were born well, healthy.

The doctors brought them healthy".

No, I brought her healthy!

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

much more beautiful, everything could have been much richer

for me as a woman, for me as a mother,

So yeah, frustrating, very frustrating.

I still want to cry. It's not right!

Other mothers had the same experience I had.

It should've been a beautiful moment unlike what it really was.

I feel sorrow, I'm angry,

and I'm even afraid of my next pregnancy.

Right after Pedro was born

I started studying. I should have studied before.

I started studying the history of childbirth and I said:

"Hey, so now I will give birth to Nina naturally".

But the problem, I mean, the doctors said

that the C-section had been very recent.

I know that nowadays it is a common strategy,

"once you have a C-section, you'll always have C-sections".

And I said: "I'm not going through my whole life

without delivering naturally."

I can't deprive myself of having that experience.

And it was great.

It was this overwhelming experience, and then Nina came.

I was in labor for 12 hours it was an amazing experience.

And I felt I could leave this world happily

that's exactly what I felt.

I felt like if I had given birth. It was our thing, me and Nina's.

DELIVERY

Going into natural labor means that the baby is ready to be born.

But what exactly makes a baby be born on the 4th, the 28th, or on the 10th?

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

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 healthier than those who were taken out,

who were sleeping like kings in the womb, and suddenly

you yank them out like "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.

Labor plays a fundamental role in birth.

Regarding safety,

which is a very important concern to the mother, obviously,

it is much safer to respect physiological conditions of birth

than other varieties, such as:

"Be here tomorrow at 4 PM and your baby will be born at 5."

And we didn't ask the baby.

When I decided to be a mother,

I decided I wanted a natural childbirth.

It was not at all easy as it took eight hours and the pain was intense.

The way we conducted my labor…

MÃE AND BUSINESSWOMAN

…didn't make me think about giving up.

We used palliative pain management,

such as acupuncture, massage.

I spent the whole labor with my doula and my husband, which was fundamental!

We dimmed the lights, I listened to music.

I managed to focus.

I had this strong connection with my body.

In the end, I found everything was beautiful.

I think natural childbirth is a 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, they bleed less.

So anemia is unlikely,

and there is less risk of infection.

Actually, even high-risk pregnancies, in general,

will benefit from normal birth.

When I pictured myself pregnant… I have three girls.

I've always wanted to be a mother, always considered normal birth,

I had this instinct that this would be better,

and much more pleasant, and it'd be more fulfilling.

Before birth, there was that challenge too…

OBSTETRICIAN

…I heard in the hospital where I worked that for ten years

no physician had given 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 I felt very powerful afterwards.

That's very interesting because today

I am an OB-Gyn, so I'm a role model for my patients, I lead by example, right?

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

I really believe in what I'm offering them!

LABOR PAIN

For us, women from western Judeo-Christian civilization,

that biblical saying has a great impact, "with pain will you give birth".

As if becoming a mother were 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 experience pain during labor,

but testimonies reveal that most of the complaints

are mostly about the emotional abuse they've suffered,

unnecessary interventions, not the childbirth itself.

Childbirth is like mountain climbing.

You have to carry a backpack.

Prenatal care is packing.

It's the assurance of a low risk pregnancy

and that it's all fine.

Probably, when you're almost at the end of the hike, you will get cramps

and think you can't take it any longer.

Then you stop, breathe and think, "If I could get this far, I can go on."

That's the beauty of it! It's the possibility

of transcending limits, no matter what they are:

tiredness, pain, sleepiness, hunger, it's the will to endure.

So you connect with your inner self and say:

"I can handle it!" Then you go ahead!

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

and it is totally different from getting there by helicopter.

You accomplished it yourself!

Pain and suffering are not related at all!

It's very important.

The hurtful contraction during labor lasts one minute.

After that, you'll have three, four, five minutes, of total relaxation,

some women fall asleep between contractions.

Birth is not only a physiological act starting with the contractions

and ends with the baby being born.

It is a true rite of initiation, of passage

for the mother and also for the family and the baby

who has an active role and comes out stronger from it.

People think that childbirth is something bodily.

A process of a baby coming out.

Just the physical aspect.

But the more years I attend births,

I see that birth is her soul expressing itself through her body.

With the right conditions,

birth can be the most transcendental moment

in the life of a woman,

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

If I could give birth, I would!

Why would a mother give up

on her 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 just consume.

It is such nonsense that we use drugs,

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

We can go through tragic moments,

as well as feel that life is strong.

But labor is a moment that is not tragic

and is simply given to us as a gift.

We celebrate weddings that won't last a year.

We sometimes spend a fortune and take years to prepare

for so artificial and empty events.

And labor and birth alone naturally,

provide us a situation

where we find a power as a human being,

that feeds us, shapes us and fortifies us!

So when I see that we have 52% of C-sections in Brazil,

I say: "We are losing opportunities."

HUMANIZED CHILDBIRTH

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,

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 evidence-based information

so that women may write their birth plan.

Not separating mother and baby and letting them eye to eye

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 ºF.

And he shouldn't be received at 64ºF or 68ºF,

the temperature inside an OR.

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

with the least possible sensory stimuli,

because it upsets him.

And I can check everything I need when he is still in mom's arms.

I don't need to give him a bath,

or to remove the vernix, which is very important for his protection.

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

because he is premature or has breathing problems,

The later I cut the cord and separate him from his mother, the better!

That's a major challenge for us all.

We will only truly humanize childbirth

if we return to women full control over their destiny and birth.

The three fundamental pillars of birth humanization are:

Firstly, handing protagonism back to women, which is fundamental.

Secondly, provide a broader integrative view of the phenomenon

not just from a mechanical and physiological view.

But also including psychological, affective, emotional, spiritual,

cultural and in the 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.

In 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 as licensed professionals for birth care,

OB/GYNs, family doctors,

nurse-midwives and certified professional midwives.

The so called midwives attending births in hospitals are in fact

nurse-midwives or certified professional midwives - CPM

new to the Brazilian market.

This model that we have in Brazil

to certify the CPMs, an international model,

is based on the risk assessment throughout pregnancy.

Every prenatal appointment we assess what's out of the ordinary.

If anything abnormal shows up at any moment,

I direct her to high risk care,

to doctors from a reference hospital

so she can have a more specialized healthcare.

As long as she remains low-risk,

I can continue her care.

What is the evidence available?

There is this systematic review published in 2008

which shows that midwife-led or nurse-midwives models of care

have several advantages for low-risk mothers

over the traditional medical-led models.

We dream of being able to comprehend that,

especially 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 situations so peculiar,

so delicate and unique as the birth process.

Nowadays, most births happen in hospitals.

We know that, for a low risk birth, the hospital environment

does not make the mother feel competent,

and capable at that moment.

It's not just about a vaginal birth.

I have assisted deliveries where women gave birth in extraordinary ways.

If she needs to walk like a beast around a tree

to enter this birth energy, she must do it.

She must be given the possibility.

If she needs three days to give birth,

my goodness, she must have those three days.

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

according to the WHO, is where she feels safe.

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

Others 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 they feel safe closer to technology.

The health system must offer all these alternatives to women,

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

When I got pregnant with Felipe, I said:

"I had a C-section, a hospital birth,

now, that's what I need, I am going to birth Felipe at home."

And then it was like a widespread concern.

But after seeing, and understanding, and studying,

and I only agreed after I understood and

after having had access to good literature,

not the literature imposed on you and written to scare you about it.

It was so cool.

We stayed in bed, in our room, watching movies, massaging.

Such a great energy!

Then we took a walk in the living room because the pains were coming.

You have to go through it but I don't regret it.

I'd do it again!

It happened at night, the house was silent.

It was good, we were in peace.

And finally Felipe decided to come out.

And I realized that it was much simpler than anything else.

THE BIRTH OF FELIPE WAS SUPERVISED BY AN OBSTETRIC NURSE

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

The water didn't break, I opened it.

Oh, it was so…

It even makes me want to have another one.

It was so beautiful! And the coolest part was that

Felipe came directly to my chest and stayed there nursing for two hours.

In the morning my kids said: "Can we visit Felipe?"

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

It was unbelievable!

I remember being at the maternity, without any access, besides looking.

Nothing compares to the emotion of living

this moment as it should be lived.

With feel, with contact, with your warmth, your voice

with all the suffering,

because it's not easy without anesthesia,

But Andrea gained a lot going through that, as everyone does.

I believe anyone who goes through such a moment gains a lot.

I felt very capable.

I felt strong, you know? A lioness.

A mother who did her best for her son.

Planned home births exist worldwide.

We have it in Holland, England, Japan, Canada, Australia, New Zealand.

There are different homebirth models.

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

One of them is the traditional midwife model

in North and Northeast, which exists in great quantity.

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

Which is a paradox: sometimes they need a C-section,

and it takes two days to get there by boat.

I started helping babies in the rural area.

Sometimes even went by donkey or horse.

TRADITIONAL MIDWIFE

Women would call me and I would go.

I delivered my sisters too, helped my mother.

When the TBA arrived, I was holding my sister.

I already delivered in a carriage…

TRADITIONAL MIDWIFE

…on the ground, in the woods,

under a tree, on a banana leaf.

There was a hospital, but their conditions

to get there were thin.

Because we 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 BIRTH

And there is another movement, which is growing a lot

which is the homebirth in urban centers

assisted by a nurse-midwife or a certified midwife

or even by doctors who work according to this model.

Homebirth is for low-risk women without complications.

We go equipped with a set of materials for attending a birth,

for normal situations, such as gloves, gauze,

things that we are going to need to assist.

And also for more complex situations.

So if I need to stitch, I have stitching thread.

I can apply local anesthesia.

I have some kind of medication for hemorrhage.

Oxygen if the baby needs it, neonatal resuscitation material.

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

We have today at our disposal, to understand home births,

retrospective and prospective studies in which we look at a group of women

who have given birth at home or in a hospital

or a group of women that will have a baby at home or in a hospital.

And studies conducted abroad with a huge number of women

which tell us that homebirth is as safe as a hospital birth.

A Dutch study published in 2009 with more than 500.000 childbirths,

demonstrates the safety of planned home birth

in terms of perinatal outcomes very similar

to those in low-risk planned hospital births

and with a much reduced number of medical interventions.

In a domestic environment there are bacteria from that environment.

They are favorable to mothers. They are friends.

You'll never have an infection in a domestic environment,

as one would in a hospital.

In a health care scenario,

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

of trained care providers, such as the midwife,

nurse-midwife or even a doctor,

is possible to gather information

that can allow a decision on whether it can be a homebirth or not.

What in fact makes a difference

is prenatal care and identifying risks,

because risks also exist inside the hospital.

In home birth, it's not that the baby will have to be born at home

because she planned that way.

The woman in labor stays at home as long as everything is normal.

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

we go to the hospital and birth ends there.

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

but with some intervention that we cannot perform at home

because interventions adds risk to childbirth.

Every woman will feel safer in a different environment

and many times that place is a hospital.

So we know that homebirth is maybe for a few people.

Our minds still works very attached to the hospital model of care.

It's important that all women have the choice of home birth

to understand that if it can happen at home, it's not so complicated.

SOLUTIONS

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

Everything that happens in capitalism is determined by consumer demand.

This nice childbirth will happen due to women demand.

We have to improve the quality of information for women,

using simple language, in simple leaflets,

so they can say: "Don't cut me, because I know what I'm missing.

"I don't want to be cut, nor saline solution, neither Pitocin".

Let's teach everything about childbirth to those who are 14, 15 years old.

The same way they study Geography, History, Grammar, Childbirth!

That's more than sexual education. That is education for life!

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.

If you only offer her a bad option for birth,

full of interventions, violent lying on her back with her legs spread,

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

Yet, if she can choose everything concerning

her delivery, the birth of her son,

then you have a wide range of options.

If she is aware of her decisions,

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

Practitioners 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, 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,

and many times attacking the building process of the human birth

more than seven million years old.

That 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 collapsing societies

that did not know how to deal with their ecological challenges.

I 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?

If it starts being useless?

What does that mean in terms of civilization?

I decided: "my next daughter will be born

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

I sought for information.

I found a wonderful doctor, an amazing doula and my family who,

though not accepting my idea, respected me.

And the birth was marvelous, at home.

At dawn. Peaceful.

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

I have never had such a feeling in my whole life.