MIDWIFERY TODAY

Nº 90 - Verão de 2009

Brazil is a huge country with different modalities of childbirth assistance in each region. We have 18 thousand of obstetricians, 6 thousand obstetrical nurses and 60 thousand traditional midwives. These midwives work in the rural area of the north of the country and the obstetricians are concentrated in the urban area.

Our c-section rates can climb up to 99% in private hospitals and at the

same time, if you need a c-section in the Amazon forest, the nearest hospital

can be two days away, by boat, crossing small and big rivers.

In Brazil we have a rate of maternal and perinatal mortality that puts us

in worse conditions than Tunisia, Thailand and Mexico, among others, and

very close to countries like Peru and the Philippines. Another relevant fact is

that for each registered maternal death, another woman suffers damages to her

health, often irreversible ones. Every year about 15 million women experience

severe complications related to the way they were assisted in childbirth

(Mirsk, In Santos, 2001).This tragedy can be avoided because it is intimately

associated to social injustices at all levels, to poverty and mainly to the lack of

a minimum warranty of their reproductive rights, as well as the lack of

implementation of an appropriate model of attendance to pregnancy, childbirth

and postpartum. (Santos,2001)

To have better outcomes in 1984, a Public Health program came into

existence, the PAISM. (Program of Integral Assistance to Women’s Health ),

and with this new paradigm fiercely introduced by the feminist movement, the

concept of natural vaginal birth started to be re-born in the urban areas.

A good example of this occurred in May 28, 2003 when the Minister of

Health signed two documents implementing specific strategies to reduce

Brazilian perinatal mortality rates. In these strategies, is included a financial

support to continuing educational programs for traditional midwives, as well

as specialization courses for nurses who want to become nurse midwives. This

means that Brazil has now the support of its government to promote natural

vaginal birth and the humanization of the assistance to women and children.

In the nineties, the Brazilian movement for the humanization of

childbirth grew. ReHuNa – The Web for Humanization of Childbirth and

Birth - a National NGO which gathers institutions and professionals working

in the field of childbirth and birth. It is a movement for the improvement of

childbirth and birth attendance. The resurrection of ABENFO – the Brazilian

Association of Obstetric Nurses, in 1992, its growth and social penetration

should also be mentioned.

The humanistic model is growing quickly and occupying new spaces in

the Brazilian national scenery. Today we have in Rio de Janeiro, under the

jurisdiction of the Municipal General Office of Health, resolutions, norms and

routines that assure the humanization of the attendance. Under this umbrella,

several hospitals have brought back the obstetric nurse in the laboring and

birthing rooms, have beautified their environment in order to offer a

differentiated attendance that represents a shift of paradigm toward the

humanization of childbirth. While the companion’s presence in the delivery

room is encouraged, routines such as enema and episiotomy have been

removed from the manuals of natural birth attendance produced by the

Ministry of Health (2001).

At the Conference in Fortaleza, (To Humanize Childbirth), attended by

2000 persons in the year 2000, we Brazilians experienced a wonderful and

empowering crosspollination that transformed and enhanced our work under

the banner of the humanization of childbirth.

Since this seminal Conference, Brazil has hosted a dozen of events,

featuring outstanding proponents of the relevance of pregnancy, birth and

breastfeeding for a healthy ecological society, like Michel Odent, Robbie

Davis-Floyd, Naoli Vinaver Lopez, Mary Swart, Laura Uplinger and Ina May

Gaskin. One of this occurred In 2002, the first Congress ~ The Ecology of

Childbirth- A Celebration of Life~ attended by 850 persons, launched the

ideal of the physiological and ecological birth as a means for the woman and

the baby to deeply experience a connection with themselves, their

environment and the cosmos. Such connection carries the power of

transforming the way we live. We consider that this expression Ecology of

childbirth represents and contains the whole idea of the relationship between

physiological childbirth and cultural, anthropological and cosmic events

together at work when a new human being is born.

In Oaxaca this year (2003), at the Midwifery Today Conference,being

together with traditional parteras from Latin America and also with

professionals many of the participants were able to realize that the knowledge

of the parteras needs to be protected and deserves to be rediscovered by

society at large. Meeting all of them made me feel like I was in Acre our

Amazonian. The energy of the group, is the same of the woman in the forest.

They way they love their work as a mission, the solidarity, their open heart

and the anxiety to learn with any new experience are all the same.

Birth professionals around the world, need to be aware that a good way

to have better birth outcomes is to reduce the number of interventions .We

need to reclaim the old skills that were once developed before the c-section

age, and we need to do it before it’s gone totally. In this aspect Brazil has an

important role to play due to its great number of traditional parteras and its

cultural relevance in Latin America.

Our next step will be: The 2 º Congress The Ecology Of Childbirth –A

Celebration of Live that will occur in May 27-30 in Rio de Janeiro, Brazil. We

have the pleasure to invite all of you to share ideas and ideals to transforming

the scene of birth to come to Rio de Janeiro and share your knowledge and

enthusiasm with participants from, Latin America, Europe, United States and

all the different regions of Brazil.

We are working hard to organize a Congress that can help our daily

mission. A Congress also plenty of samba, hugs, kisses and friendship..

We wish to have many of you in Brazil!!

Sejam todos Bem-Vindos!! ( You are all welcome!!)

Heloisa Lessa