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Modern Obstetrics and Midwives Need to Join Forces

RIO DE JANEIRO, May 4 2012 (IPS) - María dos Prazeres de Souza has lost count of the number of births “without a single death” she has attended as a midwife, an occupation that there is renewed interest in strengthening in traditional communities in Brazil where state services are not available or are not entirely acceptable for cultural reasons.

In countries like Mexico, where this indigenous baby was born, and Brazil, many mothers still give birth at home, attended by midwives. Credit: Mauricio Ramos/IPS

In countries like Mexico, where this indigenous baby was born, and Brazil, many mothers still give birth at home, attended by midwives. Credit: Mauricio Ramos/IPS

The 74-year-old de Souza says that prior to 2008 she attended 1,000 births in her home city of Jaboatão dos Guararapes, in the rest of the state of Pernambuco, and in neighbouring states in Brazil’s impoverished Northeast.

She said she never ceases to be amazed every time a mother’s expression changes from pain to joy.

“A woman in labour feels pain, but when her baby is born she smiles and cries with happiness,” she told IPS, recalling the tears of emotion she has shed herself at each birth she has attended.

De Souza, an indigenous woman, learned her skills as part of her cultural heritage. Her mother, grandmother and great-grandmother taught her the skills from childhood.

“At first I would attend the births of cats, dogs and other animals, but later on in emergency situations, when my mother was not available, I began to attend women in their homes,” she said. Subsequently she trained as an obstetric nurse and worked in hospitals for 20 years.

Now retired, she still attends home births, sometimes “in exchange for just a thank-you hug,” like many of her colleagues who are midwives in the poorest parts of the country.

“It is undeniable that the technologies and practices of the official health model have brought great advances, but we must try to achieve a balance between the traditional and the biomedical approaches if we want to guarantee the health of mothers and children, not just physically but also mentally and spiritually,” said Paula Viana, coordinator of the Curumim Group Midwives Programme in Pernambuco.

Because of their wisdom and experience, midwives should be integrated in, not excluded from, the health system, Viana said in an interview with IPS.

The Curumim programme has shown that traditional midwives contribute to earlier identification of problems in pregnancy, and that as natural leaders they help in cases of women who have been raped, in vaccination campaigns or in HIV/AIDS prevention programmes.

Midwives have contributed to the increase in prenatal checkups at public health facilities and healthy practices like breastfeeding, while they provide therapies such as massages, relaxing baths and emotional support.

The Curumim Group, on the occasion of International Day of the Midwife this Saturday May 5, is launching a campaign for recognition of the value of the role of traditional midwives among indigenous people and in “quilombolas”, communities of descendants of escaped slaves.

The campaign is also seeking recognition of home births attended by midwives within the Sistema Único de Saúde (SUS), the Brazilian national public health system, as well as the designation of midwives’ knowledge and practices as part of Brazil’s intangible cultural heritage.

“Traditional midwives are the bridge between the community and the health services. In many places where there are no doctors, they provide primary health care for the general population, and at other times they are the only person with the connections to get a sick person to hospitals or health clinics in nearby cities,” Viana said.

De Souza has personal experience of the isolation of many rural, riverside or jungle communities. Once she attended a birth on the second floor of a half-built house that still did not have a stairway, so she had to climb up a rope rigged precariously by two police officers.

“After the birth I had a lot of trouble getting down on my own, because one of the police officers was carrying the baby and the other was carrying the mother,” she said.

According to Health Ministry statistics, 41,000 women a year give birth at home in this country of 192 million people, most of them attended by midwives. But the authorities admit the number may be higher.

Although health policies and projects officially take home births into consideration, “the fact is that these births mostly take place in marginalised and isolated communities, without the involvement of the SUS,” Viana said.

“Traditional midwives can probably teach more than they can learn,” but like any other health professionals they must train to improve and update their skills, and must have access to adequate materials and equipment, as well as means of transport for emergencies, she said.

De Souza said many of her colleagues in Brazil have no social benefits or labour rights, and receive no recognition for their work.

“The government has to address this issue, especially as we have had a Brazilian president who was brought into the world by a traditional midwife,” the expert said, referring to former president Luiz Inácio Lula da Silva (2003-2011), who is from the Northeast.

Viana emphasised that “risk is inherent to childbirth, whether it takes place in a woman’s home or in a hospital.” But the danger of a serious health complication would increase if “women in labour were deprived of the support of traditional midwives,” she said.

That is why the Curumim Group’s representative is calling for “both healthcare models, the traditional and the biomedical, to join together,” especially in remote and isolated communities.

In de Souza’s view, pregnancy is a natural process, but “many women have got it into their heads that they are ill, or else they don’t want to suffer pain and they ask for a caesarean.” SUS figures for 2008 show that half of the three million births registered that year were by caesarean section.

The maternal mortality rate has declined steadily in Brazil since 1990, when there were 140 maternal deaths per 100,000 live births. By 2010 the figure was 58 per 100,000 and it is expected to drop still further. The main causes of childbirth-related death among women are hypertension, haemorrhages and postpartum infections.

The infant mortality rate has also fallen, to 15.6 per 1,000 live births in 2010, 47 percent lower than in 2000, according to the latest census.

In these circumstances, Viana said, the full range of regional obstetric care should be considered in order to achieve further improvement.

“The more the scientific community endeavours to establish the biomedical model of health, the more we need to analyse the consequences of the excessively interventionist and medicalised nature of childbirth,” she said, pointing out that the number of traditional midwives is in decline.

De Souza, the midwife who has brought more than 1,000 babies into the world, says: “We have been blessed, and we continue to be blessed. We have thousands of years of history behind us, and that must command respect.”

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  • Jeff Marston

    I can see how the mother could benefit from the service of both an obstetrician and a midwife. It seems like a great way to make sure that both the mother and the baby are healthy and safe. My wife is pregnant with our first child and so we’ve been thinking about the delivery and I just hope that everything goes well.

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