Brazil is today considered the leader in cesarean sections. While the recommendation of the World Health Organization (WHO) is that 15% of births are via cesarean section, in the country, in the private network, the rates reach scary 82% and in the public network, 52%.
Milena Brandão Seko, mother of two daughters, biologist, doula, coordinator of the active childbirth support group Gesta Maringá and breastfeeding consultant, comments that Brazil is culturally a Caesarean country, where the vast majority of women opt for this. type of surgery without even knowing the risk / benefit factors for the mother / baby binomial ?, he says.
Alongside this, Milena points out, is there information missing about the natural (vaginal) mode of delivery? which is surrounded by myths. "In fact, the fight in our country has gone against the other countries, where we have to fight for the right to have a normal birth, since here the traditional way of delivery is surgical," he explains.
It is in this context, in a country where most births are by caesarean section, that many women? by its own decision or even for sure? incentive? some professionals? They do not even think about other possibilities and have their children through cesarean section.
Alberto Jorge Guimarães, gynecologist and obstetrician at the Faculty of Medicine in Teresópolis and master at the Paulista School of Medicine (UNIFESP), defender of the concepts of Humanized Childbirth, emphasizes that, first, it is necessary to understand that childbirth belongs to women. “So she has the right to plan, to expose what she wants. In prenatal care, planning what she expects is very important. A lot of people today think that? Lost that right? to choose the type of delivery you want, but not true ?, he says.
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But, in the case of women who choose cesarean section, warns the obstetrician, the greatest care is not to mark it early, simply at a convenient date.
Guimarães comments that, despite the large number of cesarean sections performed in Brazil, there have been some movements that aim to resume normal delivery. In São Paulo, through the Mãe Paulistana program? Safe Birth, which I am part of, we managed to greatly increase the number of normal births ?, says.
? I find it very beautiful, interesting this movement to rescue the normal birth, the natural birth? I realize that most women who choose this type of delivery feel much safer than those who have not even tried. I think it is very important for professionals to help women understand that they are capable, who "realize", that they do not always need interventions, "adds the obstetrician.
Milena points out that she defends "always the right to informed choice of women on how to give birth".
This is exactly why it is crucial that women know more about the different types of births, so that informed women can decide what they think is best for them.
Different types and denominations of childbirth
Here are the details about each way to give birth to a child:
1. Natural Childbirth
Ariane Munhoz, nurse at AzimuteMed, explains that this is the type of birth in which the baby is also born vaginally, but differs from normal birth because it is performed without interventions such as analgesia, use of oxytocin to stimulate contractions or procedures such as episiotomy ?.
In this method, Ariane adds, care is centered on women, where their needs and choices are respected and thus humanized. Thus, the pregnant woman can choose the place where she wants to give birth, for example, at home, or also in the hospital. Choosing who wants to accompany you at this important moment is essential and, in this case, is respected ?, he says.
Guimarães reinforces that in this type of delivery there is practically no interference. The procedure is only assisted, does not let the woman? She expects her to go into labor, give birth spontaneously, she has no medicalization, etc. Is it a process more of the mother ?, says.
But, the obstetrician explains, sometimes even in a humanized birth there may be interventions if the woman needs help. “That does not mean it will no longer be humanized. But if the woman drinks water, is free to moan, can she move, change her position? Is it a humanized birth that is not necessarily natural?
In addition, Guimarães points out that many people have a wrong idea about natural childbirth. "You think it's a 'dropped thing', 'hippie thing', but that's not it. A natural birth can be a hospital birth, respecting the privacy of women, as natural as possible ?, says.
2.Normal birth
It is also known as vaginal birth, because the baby's exit is vaginal. Ariane explains that it is spontaneous in onset and the baby is born with a cephalic presentation, that is, its head is positioned in the pelvis, as it is already prepared for birth.
? Even if in the correct position, difficulties may occur when the baby exits and in these cases an episiotomy may be performed? a surgical cut made on the perineum, the muscle region that lies between the vagina and anus. It is important that this procedure be performed only as needed ?, highlights Ariane.
In this type of delivery, in addition to episiotomy (to facilitate the baby's exit), analgesia and induction of contractions with oxytocin-containing serum may be used in some cases. For this type of delivery to happen, it must be all right with the health of the mother and the baby.
Guimarães points out that the benefits of normal birth are numerous. • For the baby: guarantee of a mature lung; contact with the mother in the first moments of life; opportunity to suck the chest; less chances of respiratory diseases etc. For mother: less risk of bleeding; faster recovery; monitoring of delivery and completion of a life cycle (pregnancy); faster contact with the baby, among others?
3. Waterbirth
Ariane explains that waterbirth is one where the birth of the baby happens to the mother immersed in water, in a bath or pool. Should the belly be completely covered by water? And can the father stay inside the bathtub or pool to support the pregnant woman at this important moment?
The nurse points out that the pregnant woman is placed in a bathtub filled with warm water during labor. "She usually goes into the bathtub when labor progresses and the pain increases," he says. "The orientation is usually that the pregnant woman enters the water after a cervical dilation greater than 5 cm and feeling frequent and intense uterine contractions (more than 2 every 10 minutes)."
Some people have a certain fear about this type of childbirth and ask, "Will my child not drown?" But that doesn't happen, because when the baby is born, it still breathes through the umbilical cord for at least twenty seconds, during which it slowly expands its lungs.
4. Squatting childbirth
It is performed in the same way as the natural, only changes the position of the mother who, instead of being in the normal gynecological position, remains squatting. It is usually a faster delivery as it is aided by gravity due to the upright position. It is therefore generally more comfortable for women ?, says Ariane.
This type of delivery respects the physiological process of delivery, as well as the needs and desires of the pregnant woman, as highlighted by Ariane. It is also humanized, can be performed at the place of preference of the pregnant woman, there is the participation of the partner and has some advantages such as the absence of invasive methods for pain relief, the freedom of movement given to the woman at the time of child birth and immediate recovery?
5. Childbirth
Ariane explains that a forceps delivery occurs when a normal delivery evolves with difficulty for the baby to leave. "Forceps is an instrument formed by two elongated and connected parts that bend at the tips to house the baby's head," he says.
The nurse also explains that it is necessary to perform episiotomy in the perineum for the introduction of forceps and positioning in the baby's head. With the forceps adjusted, the provider will pull while the woman forces to push the baby during a contraction.
"Different reasons may lead to the use of this method, such as situations where there is fetal distress or the mother is no longer able to force," says Ariane.
In the past, the use of forceps was synonymous with suffering, but today the instrument plays a reverse role, relieving labor and sparing mother and baby wear if necessary.
Nevertheless, it is considered a controversial technique, according to Ariane, because forceps delivery could pose a higher risk if the instrument is not used correctly, causing injury to the mother and baby.
6. Leboyer Childbirth
Also called "non-violent childbirth", it is a type of childbirth where one tries not to stress the baby, making her first experience outside the womb less "traumatic". It was created by French obstetrician Frédérik Leboyer and introduced to Brazil in the 1970s.
The idea is for the birth to be done in a tranquil environment, and what? possible with the maternal uterus. For this, Ariane explains that low light is used (not to disturb the baby); silence (especially after birth); warm environment (such as the mother's abdomen) in order to mitigate the impact of the difference between the intrauterine and extrauterine worlds etc. Breastfeeding is early and bathing is performed with parents.
7. Humanized Childbirth
Milena points out that humanized childbirth is an attitude and not a method. "Women are the protagonists of the birth of their child, where their choices are respected and discussed with professionals with this view, using evidence-based medicine," he says.
“For example, the woman is not called a 'mommy', but rather by name because she has an identity and is unique. Thus, care is individualized and not standardized. And this is really a challenge, because a change of mindset is needed as a whole ?, says Milena.
The doula adds that in humanized childbirth, the position to give birth will be respected, the mother / baby time for birth will be respected, the place of birth (on a birth stool, in the bath or bed) and perineum will not be cut without the consent (episiotomy) of the pregnant woman. This woman is also free to feed and move during labor? He says.
In a nutshell, humanized childbirth still refers to a childbirth that is treated as a normal physiological process that requires only interventions in a minority of cases.
In humanized childbirth, the caregiver is a? Guide? It works in partnership with the woman and respects her choices as much as possible, guiding decisions and not simply imposing protocols.
8. Cesarean
Cesarean section is performed transabdominally, that is, with the incision of the mother's abdomen in several layers until it finds the fetus inside the womb and removes it through this incision. Anesthesia, usually spinal anesthesia, is used. After the baby is removed, the placenta is removed and each open plane sutured.
Ariane explains that cesarean section is a medium or large surgery and an invasive procedure. "It is a technology originally designed to be used only when there is a risk to life for the baby or mother," he says. According to WHO, the optimal cesarean section rate should be around 7% to 10%, not exceeding 15%.
Alberto Guimarães points out that cesarean section is indicated in cases that may lead to risks. How, for example, placenta detachment? Then the caesarean section will be the salvation for the baby to breathe; eclampsia (a rare condition that causes seizures during pregnancy); during normal birth when the baby does not "go down", because the position did not work for him to be born and this is posing a risk to his life; when is the baby transverse? In these cases they are accurate indications and the cesarean section will have good use?
However, cesarean section performed indiscriminately can pose serious risks to the health of both mother and baby.
12 common questions about childbirth
The birth of a baby is a very special moment in a woman's and family's life, which is why it is normal that there are several doubts about the subject. Below, the professionals clarify the main ones:
1. What are the negatives of betting on a c-section (if not necessary)?
Milena Brandão Seko: Caesarean section is a medium-sized surgery and this implies a more painful postoperative period and incapacitates the woman to take the first care of the baby. In addition, she offers a three times greater risk of her mother dying from an elective (scheduled) caesarean section than in a normal birth. (Hall, 1999).
Basically cesarean section increases the risk of infections, bleeding, anesthetic complications. It hinders the initial bond between mother and baby, milk drop, skin-to-skin contact and breastfeeding. So she is more at risk of breastfeeding and mother-infant bonding, which is a greater risk of breast engorgement. In the long term, there is a risk of adherence, placental accretion (placenta sticking to the uterus) as well as placenta previa and endometriosis, which are inherent risks for cesarean section (especially repeat cesarean sections), increased risk for the next delivery and problems with fertility.
In addition to a 120 times greater risk of prematurity and respiratory distress for the newborn.
2. Does every birth hurt?
Alberto Jorge Guimarães: Is pain subjective? There is labor that some women can even smile at the moment. Contraction may hurt a little, yes, but is it necessary to differentiate between physiological pain, part of a process, and suffering?
If the woman has in mind that this is her mission at that time (to bring the baby into the world)? from the moment she got pregnant? surely she will give birth in the best way possible.
I see many women celebrating the birth of the baby later (through normal birth) as a great victory.
3. Are there measures / actions that can help alleviate labor pain?
Milena Brandão Seko: I always say that labor pain is not only physical but also emotional. The woman most often brings her pains and fears and traumas to labor. What makes all the difference to a successful birth is the respect and acceptance of this woman.She should be treated and viewed as someone who is going through a natural process and not as a 'time bomb'. Hot baths, massage, dialogue, words of encouragement, upright positions, a hug, a handshake are non-pharmacological methods of pain relief, and are doulas specializing in these practices? which brings relief, comfort and safety to the woman in labor.
However, there are women who need anesthetics (analgesia) and this should be discussed about the risk / benefit with the obstetrician and, therefore, childbirth becomes less humanized by this type of intervention.
4. Is it possible to require the use of hilarious gas for childbirth?
Milena Brandão Seko: Hilarious gas (nitrous oxide) is practically unknown in Brazil. In countries such as the USA and Canada, its use is common to relieve the pain of labor contractions. In our country, will start testing at Sofia Feldman hospital in Belo Horizonte.
5. What are the advantages of hiring a doula?
Milena Brandão Seko: The word doula comes from the Greek and means "serving woman." The doula works in the preparation of the pregnant woman for childbirth, bringing to her quality information, based on scientific evidence. Accompanies women in labor, providing physical and emotional support with non-pharmacological pain relief methods and techniques. The doula is the main bond of women in labor, is a great supporter and encourager.
Doula is a childbirth professional but does not perform medical and nursing procedures. It must not interfere with the conduct of the medical staff.
Postpartum, it helps the woman with breastfeeding and cope with the sensitive and intensely changing phase, which is the puerperium, and in caring for the newborn.
6. When is a labor induction recommended?
Alberto Jorge Guimarães: Should it be an option after the 41st to 42nd week of pregnancy? So instead of marking the cesarean section, this would be another attempt to see if the pregnant woman went into labor.
7. Can a woman refuse the cut (episiotomy)?
Milena Brandão Seko: Episiotomy is a cut in the opening of the vagina to enlarge the birth canal. In Europe it is used in 5 to 30% of normal deliveries and in Latin America it is used in almost all deliveries. The reason is that without this cut the woman is wide, that a straight cut is better to suture, that the baby is born faster, and without episiotomy there may be larger tears at the entrance of the vagina. But according to the evidence, we have seen that when the woman will give birth in vertical positions and when the baby is gently let out through the birth canal, the risk of perineal tears significantly decreases and that preparatory exercises for this region strengthen the muscles. pelvic area bringing greater strengthening of this region for childbirth and a rapid recovery for postpartum.
The episiotomy should be discussed with the obstetrician and should only be done in case of real need, such as fetal distress; because its recovery is very painful, affects a noble region of the female body, and can have negative consequences even for sex life.
Alberto Jorge Guimarães: Lately, the idea is that this procedure is less used. In the birth plan, she can make it clear that she would not like it to be done, it is important to talk to the professional about it. There are even exercises that can be done before to improve the canal. Once she makes this clear, the cut will only be used in case of need (which is discovered at the time of delivery).
8. How long does labor last?
Alberto Jorge Guimarães: It varies widely, but usually from 12 to 18 hours, as labor begins even from regular contractions (eg 2 contractions every 10 minutes for 1 hour).
9. What are the possible complications of a normal birth?
Alberto Jorge Guimarães: The same as any childbirth, which can lead, in extreme cases, to the death of mother and baby. But only in extreme cases. The tendency is that everything goes well, this is the main possibility.
With the professionals following the baby's heartbeat, the direct contact with the mother and also with her confidence in the process, the tendency is that everything goes the best way. For this care will show if there are risks and the professionals involved will be prepared to attend the mother and / or baby if necessary.
10. How is the woman's recovery after a caesarean section?
Alberto Jorge Guimarães: Some who have never had a normal birth see no problem. They feel discomfort or other that may improve with pain killers. They have more limitations to move around; What can make baby care a little difficult?
Does the big difference feel to the mother who has had a normal birth and then has a caesarean section? These usually complain a lot.
11How is the woman's recovery after a normal birth?
Alberto Jorge Guimarães: Great. Many have just given birth and already want to get up, for example, to take a shower. Is it incomparable? They do not feel overly willing to take care of the baby.
12. Can pregnant twins opt for normal birth?
Alberto Jorge Guimarães: Yes. If the position of the first baby is adequate (he is upside down) and the weight of the two babies is similar, normal delivery can be performed if the woman wishes.
Milena Brandão Seko: Twin pregnancy, as long as it is low risk, or usual risk, may be normal delivery, provided there is an experienced care team. There are numerous reports of successful and normal twin birth.
Home Birth: Advantages vs. Risks
Some women choose to have their baby at home. ? The home is a space that favors the physiological and natural evolution of childbirth, as well as the exercise of women's autonomy, by providing security, privacy and comfort, enabling a more intense, affective, family and personal experience of this process ?, explains Ariane .
The biggest advantage of home birth, according to the nurse, is freedom. "The mother has freedom to choose, freedom of position, behavior, even to feed and move during labor, which is a natural method of pain relief," he says.
In addition, informality, the participation of family and friends chosen to experience this moment are factors that contribute to make the moment more peaceful and special.
Ariane reinforces that home birth is indicated for pregnant women without risk of complications such as diabetes, hypertension, etc. • For everything to work well, millimeter care is required from the doctor or the obstetrician nurse. Otherwise, in the absence of a hospital structure for immediate relief, the pregnant woman and the baby are at serious risk ?, he says.
Milena adds that home birth is for low-risk pregnant women and should be a conscious and informed choice. • The couple should share with the team the responsibility for childbirth and there should always be a “plan B” well-suited for possible transfers to a hospital. Often, the birth can end in the hospital and still be a normal birth ?, he says.
Milena explains that home birth is attended by Obstetric Nurses, where they are trained and regulated for such care registered with COREN. "The doula is also present in home birth, but has no technical responsibility for childbirth," he says.
Mothers report their births
Date Waldrick, 31, a public servant, had a water birth. She says that when she became pregnant, she began reading about the types of birth, the trivialization of cesarean section in Brazil and came to the conclusion that she wanted a humanized birth. “Then began the struggle to find an obstetrician here in Brasilia who would perform this type of delivery. Because health insurance is impossible, I had to pay a private one. My obstetrician was Dr. Petrus Sanches, wonderful! He has a humanized birth and during the consultations I told him about my desire to have a water birth. He agreed at the time, because he was used to this type of delivery ?, he says.
Date says he only commented to some people that he wanted a water birth. ? Because most, unfortunately, find this thing hippie, crazy etc. My husband fully supported me! Before watching the movie The Renaissance of Childbirth, my husband thought caesarean section was the best option, but after watching the movie, he realized that normal birth was much better for the baby ?, he says.
Date says her labor lasted 10 hours. I started to feel contractions at 11pm and my baby was born at 9am. But you don't feel pain all this time. When the contractions were early, I slept between them! The pain gets stronger in the last hour. I didn't want anesthesia and I can tell you it really hurts, but nothing that will kill you!
Then when I was in this moment of great pain and with 9 cm of dilation, I went into the bathtub and gave a relief! Does warm water relax you? I got in the tub and in 10 minutes my son was born! My husband participated in everything, got in the tub with me and cut the umbilical cord! ?, highlights Date.
"My birth was at Brasilia Maternity, which has a wonderful humanized delivery room, with a pilates ball, a bathtub, a woman's squatting chair, a special light, a radio where you can put your favorite music." Sensational ?, adds Date.
Melissa Aparecida Neves, 34, a physical therapist, had a caesarean section and a normal delivery. "Although I was born from a caesarean section, I always wanted to have a normal birth, always knew that I could" handle the pain of childbirth, "I was never afraid of that," he says."But my first daughter, Giovana, was the result of a caesarean section?" My doctor said at the very end of my pregnancy that if I insisted on the idea of normal birth, would the baby be at risk? I accepted his idea thinking about the good of my daughter and today I think it is no use wondering if I did right or should have insisted on my desire for normal birth ?, comments.
His second daughter, however, was born of normal birth. “I was sure of what I wanted, and knowing that everything was fine with my health and my baby's health, I decided that I would not let any doctor interfere with my decision. Everything went well with my delivery, I find the pain bearable, especially when the mother knows what she wants, knows that, in fact, her body? Is following what it should do ?? It is a natural process. Was it everything I wanted? Melissa says.
Finally, it is noteworthy that what is good for one person may not be good for another? What is important for one woman / family may not be so important for another? Thus, it is not up to anyone to judge women's decisions regarding the type of delivery chosen. The decision is up to her, but of course it must always be guided by trusted professionals.
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