Translator: Sarah Tambur Reviewer: Maricene Crus
Have you ever thought about your birth?
Were you born by natural birth
or cesarean section?
Are you familiar with the context of your birth?
Do you know if you were nurtured
in your mother's arms as soon as you were born?
Did you have the opportunity to be breastfed in your first hours of life?
For your mother, was the experience of your birth
something joyful, happy,
or was it painful, traumatic?
Why do we need to talk about human birth?
Does the way we are born influence who we are,
or how we identify with ourselves and other people?
Several studies indicate that it does.
The events related to birth
may have deep impact on our physical and emotional health,
in the short, medium, and long terms.
The famous French researcher and obstetrician, Michel Odent, says,
"To change the world, we must first change the way babies are born."
And how are babies born in Brazil?
Brazil has the highest C-section rates in the world.
Here, more than 55% of births occur by surgery.
If we think about women with access to health insurance plans,
these numbers can go even higher than 85%.
And these statistics are very different
from those recommended by the World Health Organization,
which establishes that C-section rates should be around 15%.
If we think further,
there's also a context related to obstetric care in Brazil.
In our country,
the context of obstetric care
is characterized by interventions and obstetric violence.
How has all this happened?
If we look back 30 or 40 years, births were assisted at home.
Women would give birth with the assistance of midwives or women from the community.
But with the advancement of obstetrics, the obstetric science evolved,
births left the home environment and went to hospitals.
They stopped being assisted by midwives
and started being assisted by doctors.
And, because of that, childbirth changed.
Instead of having access
and freedom of movement during labor,
women are placed in a hospital and tied up to a bed.
Instead of being able to release their natural hormones,
which are produced during labor,
a solution is administered with synthetic oxytocin,
a hormone that increases the quantity and intensity of uterine contractions.
Instead of being able to, at the moment of pushing the baby out,
adopt vertical positions that favor the baby's descent,
women are put in a horizontal position with her legs up,
and so nature won't be able to help.
Instead of having the opportunity to let the baby distend her perineum
until there's a natural expulsion of the baby, her perineum is cut.
Instead of having the time to allow the baby's natural descent,
her abdomen is pushed.
With all these procedures
and interventions that were added to birth assistance,
a model emerged, one that we call technocrat, interventionist,
doctor-centered and hospital-centered.
That's why a study shows that 25% of the women in Brazil
will declare that they have suffered obstetric violence
in an occasion that should be the most sublime moment of their lives.
And if we think a little further,
many of these interventions and procedures considered violent,
are disguised in regular procedures and protocols in the hospitals.
And, in this context, I graduated as a doctor.
I went to a public university in Espírito Santo
and I remember that, as a student,
we would assist women in labor.
They were in a collective prenatal system,
they didn't have their husband or anyone else with them;
they were alone, and we barely knew their names.
They were "patient on bed two" or "the woman on bed five."
We were worried about whether their uterine contractions were effective,
about whether their cervix dilation was evolving well,
about the baby's descent.
But we weren't worried about who that woman was,
what that baby's birth meant,
or in what context that mother would receive this new human being.
But, even so, as they gave birth to their babies,
even in such an adverse environment,
those women would smile and cry from excitement,
and they'd welcome their babies with all the love in the world.
And that's what made me fall in love with obstetrics.
I came to Ribeirão Preto in 2000.
I took my residency at Ribeirão Preto Medical School,
an excellent medical residency.
And after I ended my residency, I started working,
I opened my practice and started to see patients with health insurance.
In this context,
it became difficult for me to put my obstetric experience to practice.
Why?
Because there was a large number of women to be assisted.
Labor takes hours.
The payment provided by health insurance plans was very low.
And the way we were able to balance all this
was to schedule C-sections.
A few years into my practice
and I barely ever assisted a natural birth anymore.
And that left me frustrated and made me decide to abandon obstetrics.
I thought, "This is not good obstetrics, this is not how it works."
So I abandoned obstetrics and started working in other areas of gynecology,
since I'm also specialized in gynecological surgery.
Meanwhile, I got pregnant with my first child.
In miraculous circumstances, because I was not able to conceive.
At 32, I was diagnosed with early menopause,
and, by some divine intervention, I was able to conceive my first baby.
And, like any other woman, I started preparing.
I put together a beautiful layette, decorated a wonderful room,
I packed a maternity bag, prepared souvenirs,
but I didn't prepare for the birth itself, after all, I was an obstetrician.
What else was there for me to know about childbirth?
By the end of my pregnancy, at 39 weeks, I became afraid,
afraid that I wouldn't be able to cope with it.
And I chose exactly to reproduce the model of assistance
that I used to offer those women in the past.
I scheduled a C-section and my son, Rodriguinho,
was born in the cold and noisy environment of a surgical center.
He was born and taken away from me and spent five hours in the nursery room,
so we missed immediate skin-to-skin contact,
the first feeding,
and I got lost into maternity limbo.
After my postpartum period, I started reconsidering all that and thinking,
"Why is it that women have to go through this kind of experience?"
Because I looked at my baby and I couldn't recognize him.
Breastfeeding problems only increased:
he was weaned at two months old.
At the time, I had created a Facebook group
to exchange ideas and information about maternity with other women.
And, in this group,
I got to know women who'd had experiences very different from mine.
Women who'd had natural birth and were breastfeeding their babies,
who had a different sort of emotional bond with their babies.
And I started dwelling on this.
While searching online for a baby sling,
I met a woman who changed my life.
Her name is Thaiane Caetano, and she manufactures slings,
but she had also had a home birth.
And her testimonial on her experience was online.
I started reading that testimonial
and, rationally, I started making mental lucubration:
"She's crazy! Who has a home birth in the 21st century?"
And while I criticized her,
something in her story made sense to me.
I wanted to meet that woman
and I later met many others, who were introduced to me by her,
and through my Facebook group.
And a whole new world opened up for me.
This woman lent me a hand to show me
that the obstetric assistance she received in her house,
which could also be offered in a hospital,
was grounded in a lot of scientific evidence.
Then I rediscovered obstetrics.
I fell much in love with this new world
and, shortly after that, I got pregnant.
I got pregnant with my second child, Bianca, on my son's first birthday.
And when I saw that pregnancy test, I told myself,
"I'll do everything different this time."
And I got prepared.
I prepared as a woman, I participated in groups for pregnant women,
I did yoga.
I sought support in those women
to get empowered, strengthened,
to get informed, and to be able to rewrite this story.
During this process, I watched the documentary "The Birth Reborn,"
which was released in 2013,
and, from then on, I decided I would have Bianca at home.
You have no idea how much criticism and nonsense I had to take
from my fellow doctors and from so many other people.
And yet, I was convinced, my husband supported me the whole time,
and, on December 28, 2013, Bianca gave her first warnings,
my water broke at 1:00 a.m.
Right after that, the contractions came and I could feel the power of nature,
my body working, the pain getting stronger,
labor advancing,
and the end of all this, the reward I got of being able to take Bianca in my arms,
feel her warmth, her slippery body, still coated on vernix.
I was able to breastfeed her on her first few minutes of life,
to stay there and cuddle with her,
with my husband, with my family.
And this was the most transforming experience of my life.
Bianca was born,
but another Flávia, a new mother and obstetrician, was reborn.
Shortly before Bianca was born,
mid-October, November 2013, I started working with obstetrics again.
I took the courage; I was very much in love with it.
I was able to assist the first humanized birth in the city of Ribeirão Preto.
I remember this experience vividly.
Antonio was born in the water
and, at the moment he was born, I think I cried more than his mom.
My belly was this big enourmous
and that was God's confirmation that I was on the right path.
It was a new path, but it was my path, my journey.
And after that, after enjoying my maternity leave with Bianca,
I went back to assistance at full strength.
I studied, dove into this universe, and I put a team together.
And today we have assisted more than 150 births inside this model
in which the woman is the protagonist of the birth,
in which we offer her all the information she needs
so she can make the best decision for herself,
and in which she can experience the process of birth
in a completely natural way,
with interventions being performed only if necessary.
Also, in which evidence-based medicine is the foundation to this assistance,
and in which transdisciplinarity is real.
Today we assist births with an obstetric nurse,
a doula, and a physiotherapist.
So it's a group of professionals that help this woman get ready
for the most sublime moment of her life.
That Facebook group I told you about
is a reference on motherhood in Ribeirão Preto today
and is on its way to become a reference in the country.
We have a website, a strong group
that gathers more than 17,000 women,
connected and searching for information and mutual support.
Because I believe that with the desire women have to live this experience
we are going to change the Brazilian obstetric system,
so the statistics we saw will no longer be a reality,
so we have the opportunity to allow women
to experience human birth at its entirety.
How about you?
What can you do to help change Brazil's reality?
Help us by getting information and supporting a pregnant woman.
Learn about birth.
If you're going to be a mom, get prepared. If you're going to be a dad, get prepared.
If neither, give support.
We have a great mission ahead,
which is to change the world by changing the way babies are born.
Thank you very much.
(Applause) (Cheers)