There have been changes in delivery preferences in South America, especially in Brazil over the years. Previously, births or deliveries were exclusively done by midwives in most places especially for those who could not afford medical care. Currently, there have been changes in maternity care that have seen home-based midwifery become hospital-based with the assistance of nurses and doctors. Labor and birth were associated with cultural, ethnic, and social factors. Labor pain was considered a culturally natural process with natural birth preferred as the first choice during birth. This is contrary to the new model whereby the pregnant woman is isolated, and other things such as the use of instruments and new routines have brought about the concept that labor is a painful and pathological experience.
Vaginal birth is surrounded by myths and stories of painful experiences, thus an increased rate of C-sections performed in Brazil. The pain influences couples with high purchase power to opt for C-sections, thus a boost in the private sector (Mascarello et al., 2017). This means that technological methods in maternity care have engulfed cultural ways that were mainly practiced by midwives, hence the increase in C-sections. As such, the first freestanding midwifery unit (FMU) was introduced to work with a public hospital in 1998 (Nunes et al., 2016). These options gave midwives the responsibility of providing birth care through the process of midwifery care model. In Brazil, midwifery and nursing have been combined to provide the best care for pregnant women during delivery. Care at these facilities have, however, been aligned to providing the best care with scientific evidence.
Birthing care provided by the FMU produced outcomes that could be considered positive in terms of the neonatal and obstetric sectors. These outcomes and the positivity in them have led the Brazilian government to consider implementing this model throughout the country. The government, however, decided to implement it alongside midwifery units (AMUs’), which were part of the hospitals. These were supposed or meant to be the intermediaries between the obstetric unit and the FMU as a maternity structure (Nunes et al., 2016) Unlike FMUs, which operate independently, AMUs are integrated within the maternity hospitals that already exist. However, midwives are the ones in charge of delivery and other services involved unless there is a complication within then they ask for help from other professionals. This means that the neonatologists and the obstetricians are always available and on standby upon request by the midwives.
In the provision of quality maternity healthcare, the introduction of midwifery teams in hospitals whether permanent or not has proven to be of utmost importance, thus an improvement in healthcare and nursing. Brazil, therefore, uses culture in guiding professionals such as obstetricians towards easy delivery of the service. This is because organizational characteristics behind AMUs and FMUs create a platform that increases flexibility in birth care. For their operations, the birth care teams follow a cultural-shaped hierarchical power setting such that physicians are the highest ranked members of the activities (Mascarello et al., 2017). Apart from following cultural power hierarchies, midwives provide support and strength to both the pregnant women and their companions. This includes offering advice on how to breathe, taking a bath, massage to relieve pain, and the relevant exercise to help with the delivery.
Taking care of or offering emotional support to a patient in the maternity is considered a cultural practice that has influenced nursing in Brazil. Residents and patients prefer to have someone by their side as they try to endure the pain in birth (Coutinho et al., 2018). As much as they are aware that they are the only people in the room that can feel the pain, the moral support of seeing family or loved ones around comforts them, and this helps in dealing with the situation, thus easier delivery. The nurses in the ward might show indifference to the patients’ pain since they have seen this for a long time but a loved one would be at a better place to understand and give the necessary love and support (Coutinho et al., 2018). Nurses are just there to perform their job and move on to the next patient. A companion, on the other hand, is considered a source of strength, which helps in the control of the patients’ feeling, thus a smother delivery with less intervention.
Culture in Brazil has been used to influence healthcare and nursing in terms of birth and delivery. Midwives are exclusively involved in maternity issues, thus making them specialties that help when nurses have to attend to other patients. Midwives, with the help of other professionals, offer medical care as well as emotional support that help in smoother deliveries. The country has, therefore, used the cultural aspect of midwifery to help women who have been told that childbirth is a painful experience. This, however, has not reduced the number of C-sections performed throughout the country but it helps women in delivery. Statistics also show that most women tend to be more comfortable with midwives compared to nurses, thus making the birth care unit in Brazil better and free with the help of the government. Women still go to private organizations but the government has done its part in ensuring free and affordable health care, thus an improvement in normal deliveries.
Coutinho, R. F., da Silva Alves, T., Viduedo, A. D. F. S., & Schardosim, J. M. (2018). Labor Pain through the Eyes of Brazilian Women and Delivery Nurses. Open Journal of Nursing, 8(01), 78. Retrieved from: https://www.scirp.org/journal/PaperInformation.aspx?paperID=82109&
Mascarello, K. C., Matijasevich, A., Barros, A. J., Santos, I. S., Zandonade, E., & Silveira, M. F. (2017). Repeat cesarean section in subsequent gestation of women from a birth cohort in Brazil. Reproductive health, 14(1), 102.
Nunes, M., Reberte Gouveia, L. M., Reis-Queiroz, J., & Hoga, L. (2016). Birth Care Providers’ Experiences and Practices in a Brazilian alongside Midwifery Unit: An Ethnographic Study. Global qualitative nursing research, 3, 2333393616670212. doi:10.1177/2333393616670212. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415287/