Several mechanisms are simultaneously constructed to gain control over women's bodies: destruction of their autonomy and self-confidence, hostility to traditional midwives, healers and all women who work in care, such as doulas, transferring health care from the popular sphere to just , the hospital, in the hands of the doctor and his subordinate team.
CONSIDERATIONS ON THE BRAZILIAN CONTEXT
The history of the institutionalization of midwifery in Brazil followed the same colonizing paths as in the USA. As Barbara and Deirdre told us , the transformation of the meaning of birth and childbirth care involves both discrediting local knowledge and practices and prohibiting them and replacing them with practices and knowledge out of cultural context.
With the arrival of the Portuguese royal family in 1808, many European midwives were brought to the newly proclaimed Kingdom of Brazil. Soon after, the first medical school was founded in Rio de Janeiro, which would later train qualified midwives. However, local traditional midwives (indigenous, caboclas, black) were obviously not included in this process. Only young women, with a “certificate of good morals”, generally girls of European origin, could enroll in the course, and only those with a diploma could practice midwifery. The first qualified midwife in Brazil was Maria Josefina Matilde Durocher, better known as Madame Durocher, a Frenchwoman who graduated from the Obstetrics course at the Faculty of Medicine in Rio de Janeiro in 1834. She was a researcher and author of several articles and assisted more than 5 thousand births. She was known as a “woman-man” for her habit of always being alone, wearing clothes considered masculine, a top hat and a beard, since she often had to go out at night to attend to parturients and at that time women alone at night were considered prostitutes. Madame Durocher participated in the birth of Princess Leopoldina, daughter of D. Pedro II, and in 1871 she was invited to join the Imperial de Medicina, later renamed the National Academy of Medicine. The only midwifery schools in Brazil were located in Rio de Janeiro and Salvador, the two most important cities of the period.
With the growth of the population of the capitals, public health policies encouraged by the growing hygienist movement at the end of the 19th century brought an inflamed discourse about childcare and the importance of motherhood for the nation, as Getúlio Vargas would later say: “mothers of the homeland [ should] be educated and well cared for to bring healthy children into the country”. As a result, childbirth, which until then was an intimate family event, begins to be removed from the home and transferred to the hospital, starting to be seen as a dangerous event that requires medical care.
The consequence of the institutionalization of childbirth care in hospitals was the organization of training with technical quality for the professionals who provided these services. Therefore, from the end of the 19th century until the 1930s, there were several attempts to find an academic place for the midwifery course, which remained for a long time reduced to a kind of technical course subordinated to medicine courses. In São Paulo, the School of Obstetrics created in 1912, was attached to the Department of Gynecology and Obstetrics of the Faculty of Medicine of USP (FM/USP), and formed the so-called “midwives” (graduated midwives). It was only from the 1960s onwards that the category of the course was changed from technical/medium to superior, and in 1970, due to an internal definition at USP, the course was not included in the department of medicine and ended up being integrated into the School of Medicine. Nursing, composed of an all-female faculty. The Hospital São Paulo School of Nursing (UNIFESP), in 1939, created the “delivery course”, and in 1949 it was replaced by the specialization in Obstetric Nursing. Currently, it has a residency program in obstetric nursing.
In the period after the 2nd World War, there was a global movement to insert the technologies of war in the industrialization of the production of goods and services. In agriculture, the presence of pesticides, modified seeds and machinery from those technologies becomes evident, as a way of redirecting the production of this gigantic industry. This process in rural areas became known as the Green Revolution. In addition to being a new market for all the investment made for the war, it accompanies the strengthening of a new cultural paradigm, more mechanistic and technocratic, which now permeates all aspects of life, not just agriculture. In health, there was a substantial leap, from the development of revolutionary medicines (such as penicillin, discovered during the 1st World War) to surgical techniques developed at the expense of tortured people. In the obstetric area, the creation of tools and anesthetics consolidates the idea of childbirth as a pathological and dangerous event. Greater training and insertion of obstetricians, the use of so-called prophylactic technologies for childbirth, changing the place of delivery to the hospital, the search for deliveries with anesthesia and the advent of cesarean surgery, shaped a new model and paradigm of care (We have reached the absurd point where the doctor is the one who performs the delivery through a surgical intervention; the midwives help the woman to give birth). As a consequence, in Europe, the USA or Brazil, what happened was the exclusion of midwives, midwives and nurse midwives from childbirth care, as they did not fit into this interventionist model.
Thus, as a result of the devaluation of these professionals, the last group of midwives at USP in the 20th century graduated in 1976, during the Military Dictatorship. However, in 2005 the Obstetrics course reopened at the University of São Paulo and returned to training qualified midwives, inspired by the model of modern European midwives. That is, the midwife accompanies the woman during prenatal care and normal delivery at normal risk, postpartum, family planning, contraception, etc., in hospital care, in clinics or at home. The course lasts four and a half years and is comprehensive and based on proposals for interdisciplinarity, transversality and non-segmentation of the various fields of human knowledge. Unlike the childbirth courses at the beginning of the 20th century, the new course for midwives (currently the only direct entry course that trains midwives in Brazil is the one at the University of São Paulo) is not subordinated to the medical school, it is also composed of a faculty of women teachers, and seeks to dialogue with women's movements and the humanization of childbirth and childbirth.
Amid all these institutional transformations, traditional midwives continued and continue to work in the most diverse regions of the country, supporting women who do not have access to any institutional health service. The creation of the Brazilian Unified Health System (SUS) in the 1980s, with a perspective of universal health, opened doors to what was being debated (or what needed to be debated) at the end of the 19th century in the USA: the training of traditional midwives and their inclusion in the health system. This approximation took place in 2000 when the Ministry of Health created a work program with traditional midwives. The effectiveness of the program is debatable, as well as the relationship between the State and its power relationship with the ethnic-cultural practices of midwives. In Brazil, there is also non-institutional training in “traditional midwifery”, which is training based on the knowledge of traditional midwives in urban contexts.
Despite everything, women's bodies continue to be seen socially as a defective reproductive machine that needs intervention. Menstruation is seen as dirty and dangerous blood, which young girls learn to hide and be ashamed of; the physiological secretions of the vaginal mucosa being treated allopathically as diseases; natural cycles of a healthy body medicated with abusive use of hormonal contraceptive methods.
Supported by solid culturally built foundations, the idea of compulsory motherhood and original sin that will result in the punishment of “delivering in pain”, form in the social imaginary the process of labor and birth as emergency, pathological and highly dangerous situations. At the same time, they place the pregnant and parturient woman as extremely fragile, sick and incapable of giving birth. In this context, the intervention of the biomedical model plays an important role in “giving birth”. Therefore, several mechanisms are simultaneously constructed to gain control over women's bodies: destruction of their autonomy and self-confidence, harassment of traditional midwives, healers and all women who work in care, such as doulas, transfer of health care from the popular sphere to , only the hospital, in the hands of the doctor and his subordinate team.
The reference that we have today of labor and birth is that of a horror film: screams, suffering, purgatory, a process that is frightening and disgusting. Fear of the unknown force of nature in the human body and disgust at the woman's body that expresses that force. It is very daring for a woman to have control over her own body, and at the same time human reproduction . Therefore, the patriarchy and the heterosexist regime have been promoting, since the Inquisition until the present day, the distancing of women from their physiological (“natural”) and emotional processes. This alienation creates a powerful social structure that seeks to subdue and control women.
But the witches are waking up.
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“ Witches, Midwives and Nurses ”, first published by The Feminist Press , was written by Barbara Ehrenreich (American writer) and Deirdre English (American writer, producer and teacher), in 1973.
Bruxaria Distro , in partnership with Coletiva Feminista Nós Soltas and Editora Subta , brings this translation into Portuguese.
Download the PDF of 'Witches, Midwives and Nurses: A Story of Healers' for free here.
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