Skip to main content Accessibility help
×
Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T07:18:01.607Z Has data issue: false hasContentIssue false

Chapter 11 - Choice in Childbirth, Agency and Collective Action

Cesarean Sections and Birth Plans in Brazil

Published online by Cambridge University Press:  23 November 2023

Nick Hopwood
Affiliation:
University of Technology, Sydney
Annalisa Sannino
Affiliation:
Tampere University, Finland
Get access

Summary

This chapter explores two experiences in which transformative agency and the elaboration of innovative mediating artifacts contributed to change in childbirth care in Brazil. In the first case, we analyze how an organized group of women built cultural tools to expose the excess of cesarean sections in the private health sector, leading to change in regulatory policy. In the second case, we analyze the elaboration of an institutional birth plan model in a formative intervention inspired by the Change Laboratory methodology. Both experiences can be understood as efforts to promote social participation and informed choice, using mediating artifacts to foster agency. The processes ignited by them are also analyzed by the perspective of pedagogy of autonomy as proposed by Freire, in the sense that women are able to build knowledge and act on that knowledge in a meaningful and effective way.

Type
Chapter
Information
Agency and Transformation
Motives, Mediation, and Motion
, pp. 265 - 288
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alonso, B. D., Silva, F. M. B. da, Latorre, M. do R. D. de O., Diniz, C. S. G. & Bick, D. (2017). Caesarean birth rates in public and privately funded hospitals: A cross-sectional study. Revista de Saude Publica, 51(101), 10. https://doi.org/10.11606/S1518-8787.2017051007054.CrossRefGoogle ScholarPubMed
Barros, F. C., Victora, C. G., Barros, A. J. D., et al. (2005). The challenge of reducing neonatal mortality in middle-income countries: Findings from three Brazilian birth cohorts in 1982, 1993, and 2004. Lancet, 365(9462), 847854. https://doi.org/10.1016/S0140-6736(05)71042-4.CrossRefGoogle ScholarPubMed
Betran, A. P., Torloni, M. R., Zhang, J., et al. (2015). What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies. Reproductive Health, 12(1), 57. https://doi.org/10.1186/s12978-015-0043-6.CrossRefGoogle Scholar
Bhan, N. & Raj, A. (2021). From choice to agency in family planning services. The Lancet, 6736(21), 99101. https://doi.org/10.1016/s0140-6736(21)00990-9.CrossRefGoogle Scholar
Bohren, M. A., Vogel, J. P., Hunter, E. C., et al. (2015). The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Medicine, 12(6), 132. https://doi.org/10.1371/journal.pmed.1001847.CrossRefGoogle ScholarPubMed
Bowser, D. & Hill, K. (2010). Exploring evidence for disrespect and abuse in facility-based childbirth: Report of a landscape analysis. USAID.Google Scholar
Brasil, Presidência da República. (1990). Lei 8.080, de 19 de setembro de 1990. Diário Oficial Da União, 118. www.planalto.gov.br/ccivil_03/leis/l8080.htm.Google Scholar
Brüggemann, A. J., Forsberg, C. & Thornberg, R. (2019). Re-negotiating agency: Patients using comics to reflect upon acting in situations of abuse in health care. BMC Health Services Research, 19(1), 111. https://doi.org/10.1186/s12913-019-3902-y.CrossRefGoogle ScholarPubMed
Campbell, B. & Sedrakyan, A. (2021). Patient involvement in regulation: An unvalued imperative. The Lancet, 397(10290), 21472148. https://doi.org/10.1016/S0140-6736(21)00977-6.CrossRefGoogle ScholarPubMed
D’Gregorio, R. P. (2010). Obstetric violence: A new legal term introduced in Venezuela. International Journal of Gynecology and Obstetrics, 111(3), 201202. https://doi.org/10.1016/j.ijgo.2010.09.002.Google Scholar
D’Oliveira, A. F. P. L., Diniz, S. G. & Schraiber, L. B. (2002). Violence against women in health-care institutions: An emerging problem. Lancet, 359(9318), 16811685. https://doi.org/10.1016/S0140-6736(02)08592-6.CrossRefGoogle ScholarPubMed
DeBaets, A. M. (2017). From birth plan to birth partnership: Enhancing communication in childbirth. American Journal of Obstetrics and Gynecology, 216(1), 31.e1–31.e4. https://doi.org/10.1016/j.ajog.2016.09.087.CrossRefGoogle ScholarPubMed
Diniz, C. S. G. (2002). O que nós como profissionais de saúde podemos fazer para promover os direitos humanos das mulheres na gravidez e no parto (1st ed.). Projeto Gênero, Violência e Direitos Humanos – Novas questões para o campo da Saúde/Coletivo Feminista Sexualidade e Saúde/Departamento de Medicina Preventiva da Faculdade de Medicina da USP.Google Scholar
Diniz, C. S. G. (2012). Materno-infantilism, feminism and maternal health policy in Brazil. Reproductive Health Matters, 20(39), 125132. https://doi.org/10.1016/S0968-8080(12)39616-X.CrossRefGoogle ScholarPubMed
Diniz, C. S. G. (2014). O renascimento do parto, e o que o SUS tem a ver com isso. Interface: Communication, Health, Education, 18(48), 217220. https://doi.org/10.1590/1807-57622013.0910.CrossRefGoogle Scholar
Diniz, C. S. G. & Chacham, A. S. (2004). “The cut above” and “the cut below”: The abuse of caesareans and episiotomy in São Paulo, Brazil. Reproductive Health Matters, 12(23), 100110. https://doi.org/10.1016/S0968-8080(04)23112-3.CrossRefGoogle ScholarPubMed
Diniz, C. S. G., d’Oliveira, A. F. P. L. & Lansky, S. (2012). Equity and women’s health services for contraception, abortion and childbirth in Brazil. Reproductive Health Matters, 20(40), 94101. https://doi.org/10.1016/S0968-8080(12)40657-7.CrossRefGoogle ScholarPubMed
Diniz, C. S. G., Niy, D. Y., Andrezzo, H. F. A., Carvalho, P. C. A. & Salgado, H. O. (2016). The vagina-school: Interdisciplinary seminar on violence against woman in the teaching of the health professions. Interface: Communication, Health, Education, 20(56). https://doi.org/10.1590/1807-57622015.0736.Google Scholar
Diniz, C. S. G., Rattner, D., D’Oliveira, A. F. P. L., Aguiar, J. M. de & Niy, D. Y. (2018). Disrespect and abuse in childbirth in Brazil: Social activism, public policies and providers’ training. Reproductive Health Matters, 26(53), 1935. https://doi.org/10.1080/09688080.2018.1502019.CrossRefGoogle Scholar
Diniz, C. S. G., Bussadori, J. C. de C., Lemes, L. B., Moisés, E. C. D., Prado, C. A. de C. & McCourt, C. (2021). A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative. Medical Teacher, 43(1), 1926. https://doi.org/10.1080/0142159X.2020.1791319.CrossRefGoogle ScholarPubMed
Diniz, C. S. G., Salgado, H. de O., Andrezzo, H. F. de A., et al. (2015). Abuse and disrespect in childbirth care as a public health issue in Brazil: Origins, definitions, impacts on maternal health, and proposals for its prevention. Journal of Human Growth and Development, 25(3), 377382. https://doi.org/10.7322/jhgd.106080.CrossRefGoogle Scholar
Engeström, Y. (2016). Aprendizagem expansiva (2nd ed.). Pontes.Google Scholar
Engeström, Y. & Sannino, A. (2021). From mediated actions to heterogenous coalitions: Four generations of activity-theoretical studies of work and learning. Mind, Culture, and Activity, 28(1), 423. https://doi.org/10.1080/10749039.2020.1806328.CrossRefGoogle Scholar
Engeström, Y., Nuttall, J. & Hopwood, N. (2022). Transformative agency by double stimulation: Advances in theory and methodology. Pedagogy, Culture & Society, 30(1), 17. https://doi.org/10.1080/14681366.2020.1805499.CrossRefGoogle Scholar
Esteves-Pereira, A. P., Deneux-Tharaux, C., Nakamura-Pereira, M., et al. (2016). Caesarean delivery and postpartum maternal mortality: A population-based case control study in Brazil. PLoS ONE, 11(4), 113. https://doi.org/10.1371/journal.pone.0153396.CrossRefGoogle ScholarPubMed
Freire, P. (2011). Pedagogia da autonomia: saberes necessários à prática educativa. Paz e Terra.Google Scholar
Freire, P. (2013). Pedagogia do oprimido (Kindle ed.). Paz e Terra.Google Scholar
Giuzio Neto, V. (2015). Sentença – Processo 0017488-30.2010.4.03.6100. Justiça Federal. 24 vara federal.Google Scholar
Horta, B. L., Gigante, D. P., Lima, R. C., Barros, F. C. & Victora, C. G. (2013). Birth by caesarean section and prevalence of risk factors for non-communicable diseases in young adults: A birth cohort study. PLoS ONE, 8(9), 110. https://doi.org/10.1371/journal.pone.0074301.CrossRefGoogle ScholarPubMed
Hotimsky, S. N., Aguiar, J. M. de & Venturi, G. (2013). A violência institucional no parto em maternidades brasileiras. In Mulheres Brasileiras e Gênero nos Espaços Público e Privado – Uma década de mudanças da opinião pública (pp. 217229). Perseu Abramo/Sesc-SP.Google Scholar
Hotimsky, S. N., Rattner, D., Venancio, S. I., Bógus, C. M. & Miranda, M. M. (2002). Childbirth as I see it …. or the way I wish it was? Expectations of pregnant women towards childbirth and obstetric care in the public health care system. Cadernos de Saúde Pública, 18(5), 13031311. https://doi.org/10.1590/S0102-311X2002000500023.CrossRefGoogle ScholarPubMed
International Federation of Gynecology and Obstetrics, White Ribbon Alliance, International Pediatric Association, & World Health Organization. (2015). Mother–baby friendly birthing facilities. International Journal of Gynecology & Obstetrics, 128(2), 9599. https://doi.org/10.1016/j.ijgo.2014.10.013.CrossRefGoogle Scholar
Leal, M. do C., Da Silva, A. A. M., Dias, M. A. B., et al. (2012). Birth in Brazil: National survey into labour and birth. Reproductive Health, 9(1). https://doi.org/10.1186/1742-4755-9-15.Google Scholar
Leal, M. do C., Pereira, A. P. E., Domingues, R. M. S., et al. (2014). Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cad Saúde Pública, Suplemento, S17S32.CrossRefGoogle Scholar
Leal, M. do C., Bittencourt, S. D. A., Esteves-Pereira, A. P., et al. (2019). Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. Cadernos de Saúde Pública, 35(7), 114. https://doi.org/10.1590/0102-311X00223018.CrossRefGoogle Scholar
Lisauskas, R. (2015, July 28). Mulheres divulgam listas com os índices de cesáreas de obstetras que atendem parto pelos planos de saúde. Estadão. https://emais.estadao.com.br/blogs/ser-mae/mulheres-divulgam-listas-com-os-indices-de-cesareas-de-obstetras-que-atendem-parto-pelos-planos-de-saude.Google Scholar
Lothian, J. (2006). Birth plans: The good, the bad, and the future. Journal of Obstetric, Gynecologic, Neonatal Nursing, 35(2), 295303. https://doi.org/10.1111/j.1552-6909.2006.00042.x.CrossRefGoogle ScholarPubMed
Mattar, L. D. & Diniz, C. S. G. (2012). Hierarquias reprodutivas: maternidade e desigualdades no exercício de direitos humanos pelas mulheres. Interface – Comunicação, Saúde, Educação, 16(40), 107120. https://doi.org/10.1590/s1414-32832012005000001.CrossRefGoogle Scholar
Mendes, V. (2015, August 5). Mulheres organizam lista colaborativa com percentual de cesarianas dos médicos de BH e região metropolitana. Uai Saúde, 18. www.uai.com.br/app/noticia/saude/2015/08/05/noticias-saude,187243/mulheres-organizam-lista-colaborativa-com-percentual-de-cesarianas-dos.shtml.Google Scholar
Ministério da Saúde. (2000). Portaria n° 569, de 1 de junho de 2000. Institui o Programa de Humanização no Pré-natal e Nascimento, no âmbito do Sistema Único de Saúde – SUS. Diário Oficial da União, Seção 1.Google Scholar
Ministério da Saúde. (2008a). Guia de vigilância epidemiológica do óbito materno (Ministério da Saúde; Issue 4). Ministério da Saúde. https://doi.org/10.1002/14651858.CD004667.pub2.CrossRefGoogle Scholar
Ministério da Saúde. (2008b). HumanizaSUS: Documento base para gestores e trabalhadores do SUS. Ministério da Saúde. http://bvsms.saude.gov.br/bvs/publicacoes/documento_base.pdf.Google Scholar
Ministério da Saúde. (2009). Portaria n° 1.820, de 13 de agosto de 2009. Dispõe sobre os direitos e deveres dos usuários da saúde. Diário Oficial da União.Google Scholar
Ministério da Saúde. (2011). Portaria n° 1.459, de 24 de junho de 2011. Institui, no âmbito do SUS, a Rede Cegonha. Diário Oficial da União, 110. www.sns.gov.pt/wp-content/uploads/2016/08/Portaria87_2015.pdf.Google Scholar
Ministério da Saúde. (2020). Datasus. http://datasus.saude.gov.br.Google Scholar
Ministério Público Federal. (2010). Ação Civil Pública N. 0017488-30.2010.4.03.6100. www.mpf.mp.br.Google Scholar
Nakamura-Pereira, M., Knobel, R., Menezes, M. O., Andreucci, C. B. & Takemoto, M. L. S. (2021). The impact of the COVID-19 pandemic on maternal mortality in Brazil: 523 maternal deaths by acute respiratory distress syndrome potentially associated with SARS-CoV-2. International Journal of Gynecology and Obstetrics, 153(2), 360362. https://doi.org/10.1002/ijgo.13643.CrossRefGoogle ScholarPubMed
Niy, D. Y. & Delage Silva, D. R. A. (2016). É a mulher quem escolhe? Questionamentos sobre direitos, autonomia, conveniências e interesses nas decisões sobre cesariana. In Direitos Humanos no Brasil 2016 (pp. 159168). Outras Expressões.Google Scholar
Niy, D. Y., de Oliveira, V. C., de Oliveira, L. R., Alonso, B. D. & Diniz, C. S. G. (2019). Overcoming the culture of physical immobilization of birthing women in Brazilian healthcare system: Findings of an intervention study in São Paulo, Brazil. Interface: Communication, Health, Education, 23. https://doi.org/10.1590/Interface.180074.Google Scholar
O’Brien, D., Butler, M. M. & Casey, M. (2017). A participatory action research study exploring women’s understandings of the concept of informed choice during pregnancy and childbirth in Ireland. Midwifery, 46(January), 17. https://doi.org/10.1016/j.midw.2017.01.002.CrossRefGoogle ScholarPubMed
Pacagnella, R. C., Nakamura-Pereira, M., Gomes-Sponholz, F., et al. (2018). Maternal mortality in Brazil: Proposals and strategies for its reduction. Revista Brasileira de Ginecologia e Obstetrícia, 40(9), 501506. https://doi.org/10.1055/s-0038-1672181.Google ScholarPubMed
Parto do Princípio. (2006). Representação N. 1.34.001.004458/2006-98.Google Scholar
Sandall, J., Tribe, R. M., Avery, L., et al. (2018). Short-term and long-term effects of caesarean section on the health of women and children. The Lancet, 392(10155), 13491357. https://doi.org/10.1016/S0140-6736(18)31930-5.CrossRefGoogle ScholarPubMed
Sannino, A. (2022). Transformative agency as warping: How collectives accomplish change amid uncertainty. Pedagogy, Culture & Society, 30(1), 933. https://doi.org/10.1080/14681366.2020.1805493.CrossRefGoogle Scholar
São Paulo (Estado). (2015). Lei 15.759, de 25 de março de 2015. Assegura o direito ao parto humanizado nos estabelecimentos públicos de saúde do Estado e dá outras providências. Diário Oficial Do Estado de São Paulo, 1315. www.al.sp.gov.br/repositorio/legislacao/lei/2015/lei-15759-25.03.2015.html.Google Scholar
Shankar, A., Sundar, S. & Smith, G. (2019). Agency-based empowerment interventions: Efforts to enhance decision-making and action in health and development. Journal of Behavioral Health Services and Research, 46(1), 164176. https://doi.org/10.1007/s11414-018-9592-0.CrossRefGoogle ScholarPubMed
Souza, J. P. (2015). A mortalidade materna e os novos objetivos de desenvolvimento sustentável (2016–2030). Revista Brasileira de Ginecologia e Obstetrícia, 37(12), 549551. https://doi.org/10.1590/SO100-720320150005526.CrossRefGoogle ScholarPubMed
Tesser, C. D., Knobel, R., Andrezzo, H. F. de A. & Diniz, S. G. (2015). Violência obstétrica e prevenção quaternária: o que é e o que fazer. Revista Brasileira de Medicina de Família e Comunidade, 10(35), 112.CrossRefGoogle Scholar
United Nations. (2016). Transforming our world: The 2030 agenda for sustainable development. In The 2030 Agenda for Sustainable Development. https://doi.org/10.1201/b20466-7.CrossRefGoogle Scholar
United Nations General Assembly. (2019). A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence. Office of the Secretary General (vol. 11859, July). https://documents-dds-ny.un.org/doc/UNDOC/GEN/N19/213/27/PDF/N1921327.pdf?OpenElement%0Ahttps://undocs.org/A/74/137.Google Scholar
Varpio, L., Aschenbrener, C. & Bates, J. (2017). Tackling wicked problems: How theories of agency can provide new insights. Medical Education, 51(4), 353365. https://doi.org/10.1111/medu.13160.CrossRefGoogle ScholarPubMed
Victora, C. G., Aquino, E. M. L., do Carmo Leal, M., Monteiro, C. A., Barros, F. C. & Szwarcwald, C. L. (2011). Maternal and child health in Brazil: Progress and challenges. Lancet, 377(9780), 18631876. https://doi.org/10.1016/S0140-6736(11)60138-4.CrossRefGoogle ScholarPubMed
Viellas, E. F., Domingues, R. M. S. M., Dias, M. A. B., et al. (2014). Prenatal care in Brazil. Cadernos de Saude Publica, 30(suppl. 1), 115. https://doi.org/10.1590/0102-311X00126013.Google ScholarPubMed
Virkkunen, J. & Newnham, D. S. (2015). O Laboratório de Mudança. Fabrefactum.Google Scholar
WHO. (2010). Caesarean section without medical indication increases risk of short-term adverse outcomes for mothers. In WHO policy brief. WHO.Google Scholar
WHO. (2014). The prevention and elimination of disrespect and abuse during facility-based childbirth: WHO statement. WHO. https://doi.org/WHO/RHR/14.23.Google Scholar
WHO. (2018). WHO recommendations: Intrapartum care for a positive childbirth experience. WHO.Google Scholar
Witkop, C. T., Maggio, L. A., Harvey, E. J. & Torre, D. M. (2021). Seeing complexity: Cultural Historical Activity Theory (CHAT) as a lens for shared decision making. Academic Medicine, 96(11), 15401545. https://doi.org/10.1097/acm.0000000000004157.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×