This week we launched our Positive Birth in India scholarship program to provide free scholarships to birth professionals in India to teach GentleBirth classes. Midwifery is growing in India but so is obstetric violence and many women don’t have access to any care at all. I’m overwhelmed with the number of applicants after only 24 hours and their obvious passion for healthy positive birth for all women.

This will be our 3rd scholarship program - our first was in the US when we ran our 50 States of Positive Birth in the USA and offered 50 scholarships (one per state). As GentleBirth becomes available in more languages it is my hope that our scholarship programs will continue. Our scholarships offer a way for local women to earn an income, make an incredible difference for the families in their community and live their passion.

If you are a birth professional in India and would like to to apply for a scholarship - click here to watch my webinar and learn more.

Trigger warning for obstetric violence

Positive Birth in Brazil

Shared originally in September 2017

When I was teaching expectant parents about mindset, sports psychology and Pele’s mental practice in Ireland 13 years ago I never expected to find myself in Brazil (home of some of the most talented football players in the world) speaking to an audience of 1000 nurses, midwives, doulas and obstetricians about GentleBirth and the benefits of bringing sport psychology into birth preparation.  It was a surreal experience to say the least...how on earth did a Dublin Midwife end up here?  

My journey to Brazil begin in 2016 during a visit home to Dublin where I met Dr Monalisa Barros who was finishing up her studies in Trinity College and the Coombe Women’s Hospital.  Dr Barros has been involved in birth research for many years and is involved with a group called ‘Cirandeiras’ where local doulas, psychologists and obstetric nurses provide support and information to parents navigating their way through the very challenging birth culture of Brazil.  Dr Barros had observed GentleBirth parents in the antenatal clinics and was impressed with their level of confidence about giving birth – initially Dr Barros thought it was some kind of religion ;)  (I like to think of it as the religion of positive birth).

It’s early September and I’ve just returned after my third visit to Brazil in the last year, my first visit was to Brasilia the capital (not Rio!) and a speaking engagement at ReHuNa (Association for the Humanization of Childbirth) an inspirational conference focused on the humanization of birth in Brazil.

http://www.rehuna.org.br/

My next trip in April 2017 was to facilitate a 5 day Instructor training for the winners of our GentleBirth Instructor Training scholarship program so there would be one Instructor in each state (hundreds applied – there were almost 50 in the first group including doulas, midwives, obstetric nurses, psychologists, obstetricians and physiotherapists).  

My next visit took me first to Vitória da Conquista (via an unexpected detour to the city of Salvador followed by an 8 hour overnight bus trip with 3 incredible obstetricians).  What an experience that was! After 2 days of travel and no sleep we arrived at 7am and my first presentation was scheduled for 9am!  Over 200 attendees travelled from their cities to learn about GentleBirth and 2 days of presentations and discussions about improving birth in Brazil. Coffee saved the day!

Vitória da Conquista is the birthplace of GentleBirth Brazil as it’s where the GentleBirth team live and work.  It was also where I got to experience first hand exactly how difficult it is to have a positive birth in Brazil.

Background

There is a public and a private health care system in Brazil.  The cesarean birth rate for private hospitals is as high at 90% and around 50% in public hospitals.  Research suggests that in early pregnancy most first time mothers in Brazil want to give birth vaginally but by the time their due date comes around they’ve been convinced that a planned cesarean is fact the best option.  It has little to do with ‘getting your figure back’ after birth which is what I’ve heard from birth professionals outside of Brazil – it has everything to do with the fact that so many women experience torture during labour and outdated procedures that traumatise mothers and babies.  Until very recently partners were not admitted….neither were doulas and although there is new legislation recommending that both be admitted to support the mother in labour some hospitals refuse to admit support people. In a heartbreaking newsreport from last year a mother who was severely traumatised from previous birth experiences brought a gun with her to her local hospital in labour and threatened to kill herself if they refused to give her a cesarean….the hospital acquiesced and she was sent to prison for several weeks after her baby was born…in other cases Police have been sent to women’s homes to enforce a cesarean.  There have also been cases of rape reported in hospital….

Routine procedures can include:

• Enema 

• Shaving (in some rural hospitals)

• Kristeller Maneuver (someone pushes on your bump to force the baby through the pelvis).

• IV fluids on admission

• Synthetic oxytocin

• Immediate cord clamping

• Episiotomy

• Minimal pain relief before and after birth (epidurals are not common)

• Birth on the bed in stirrups

• Separation of mother and baby (baby is washed under a tap soon after birth)

• Antibiotic ointment/silver nitrate in baby’s eyes

• Rough handling of baby

So if that’s what you’re faced with you can see why a calm cesarean birth seems a very easy decision to make.

Despite what many people think humanized birth, is not about dim lighting and whale music.  It is a philosophy of birth that puts the mother and baby at the center of her care instead of the staff and procedures.  It respects her as a human being  - offering her kindness, compassion and evidence based care.

During the Instructor training in April we talked about informed decision making and the potential consequences for parents who opt out of the hospital’s birth plan.  

If you don’t follow the nurse/obstetricians instructions not only is it likely that you will experience verbal and physical violence – but your baby will too…let that sink in for a minute.

Hospital Municipal Esau Matos

When I visited the only hospital that provided humanized birth in Vitoria it was a sobering experience.   The hospital has about 500 births a month.. (approx. 6000 births annually) mostly high risk moms who travel from other regions.  

At the moment they have 1 birth room……there is no epidural service so pain relief is Buscopan (in some studies may shorten labour and provide some pain relief). There are 2 CTG machines.  If the mother has a cesarean it’s likely that her pain relief option is limited to Ibuprofen and she’ll be sent home in 2 days.  

As we walked through the corridors with peeling paint, we came across a new mother with a baby only moments old lying on a trolley breastfeeding her newborn as staff and strangers walked by.  Staffing is minimal, the nurses we spoke to told me that some nights there is only 1 nurse working – taking care of up to 50 women and babies.  Women who need specialist care (preeclampsia) stay in an antenatal room next to the nurses station – the equipment doesn’t alarm…but there is a window in the wall so staff can look in and observe vitals.  The hospital is undergoing an update so hopefully the facilities will be improved in the coming year, the staff are working under incredibly difficult circumstances but do their best to offer a humanized birth experience.  When women receive kind care the facilities are far less important.  Almost every mother will breastfeed and they have an award winning milk bank onsite.  I look forward to following their progress.  This trip gave me a new perspective on how good most women have it in Ireland and the USA when it comes to birth options.

My next stop was at the annual SiaParto Conference in Sao Paulo – the brain child of a local Author and Midwife Ana Cris Duarte.  When you’re surrounded by so many passionate, inspirational birth professionals you can’t help but feel hopeful for the future of birth in Brazil….for the future of birth around the world.

https://www.siaparto.com.br

So where does GentleBirth fit into all of this?  

The culture of birth isn’t going to change overnight and many women have no options…homebirth is only available to a tiny percentage of women, there aren’t enough doulas and their partner may not be admitted with them in laborr. These women are entering a combat zone. How do you help women prepare for a potential combat zone - while she’s in labour and may not have her partner with her?

The US military is now training military personnel who will be on active duty in resilience training including mindfulness.  The only thing these women have control over during that day is how they think about what’s happening to them and how they respond to the care they receive – building emotional resilience to reduce birth trauma is critical…a resilient mother will recover quicker and will have the ability to attune to her baby…and as we know that will have repercussions for society and generations to come.

I am eternally grateful to the wonderful people of Brazil who are at the forefront of the humanized birth movement there. These amazing professionals and parents have been working towards more gentle births long before my program came into being.  There’s a lot of work to do and thankfully many hands joining together across the globe to make it happen.  Thank you to the GentleBirth team in Brazil who have worked so hard over the last year to make it all happen, I’m so excited to hear the many many positive birth stories that are just waiting to be heard around the world!

Obrigado por ler (thank you for reading)

Tracy