Health in Brazil expands structure implanting Birth Centers

News from Ministry of Health!

I encourage all municipalities to join efforts to implement Birth Centers (CPNs) in Brazil, ensuring a humanized and secure assistance during childbirth to all women!!

“STORK NETWORK

Expectation is to Promote the reform and expansion of Birth Centers 280 until 2014. With these drives pregnant women will gain qualified, safe and humane assistance.

O Ministério da Saúde está disponibilizando aos estabelecimentos hospitalares que fazem parte da Rede Cegonha recursos financeiros para a implantação e custeio de Centros de Parto Normal (CPN). A iniciativa visa ampliar e qualificar a estrutura de atendimento às gestantes e recém-nascidos. Na semana passada foi publicada a Portaria nº 904 que estabelece as diretrizes para implantação e habilitação dos CPN. A expectativa é de que, até 2014, sejam implantados 280 centros em todo o país, com previsão de liberar R$ 165,5 milhões para investimento e custeio dessas unidades.

“Estamos, com esta medida, garantindo o direito das mulheres a espaços de cuidado que possibilitam uma ambiência adequada e que favoreçam as boas práticas de atenção ao parto e ao nascimento”, destacou o ministro da Saúde Alexandre Padilha. “Com a implantação dos Centros de Parto Normal, as gestantes vão ganhar atenção qualificada, segura e humanizada”, completou.
O CPN é uma unidade de saúde que presta atendimento humanizado e de qualidade exclusivamente ao parto normal. Inserido no sistema de saúde local, o Centro atua de maneira complementar às unidades existentes e é organizado no sentido de promover a ampliação do acesso, do vínculo e do atendimento ao parto e puerpério. O centro pode se localizar nas dependências internas do estabelecimento hospitalar (unidade  intra¬-hospitalar) ou nas dependências externas, a uma distância de, no máximo, 200 metros do estabelecimento (unidade peri-hospitalar).
A portaria estabelece ainda os tamanhos e as respectivas capacidades de produção dos centros. O CPN peri-hospitalar será composto por cinco quartos, com realização mínima de 840 partos/ano (média de 70 partos/mês).
Já na modalidade intra-hospitalar  deve ter cinco ou três quartos (com produção mínima de 480 partos anuais ou média de 40 partos por mês).
A equipe multiprofissional do centro deve ser composta por enfermeiros obstétricos, técnicos de enfermagem e auxiliares de serviços gerais.
INCENTIVOS – Os hospitais receberão R$ 540 mil para ampliação da área física e R$ 270 mil ou 189 mil para reforma do Centro, de acordo com a capacidade de atendimento. Para aquisição de equipamentos, mobiliários e materiais, os hospitais receberão R$ 165 mil ou R$ 100 mil, de acordo com o número de quartos. Os recursos de custeio somam R$ 80 mil e 50 mil, segundo a capacidade.
No Sistema Único de Saúde (SUS), os partos normais corresponderam, atualmente, a 63,2% dos partos realizados. Em 2012, foram realizados 1.123.739 partos normais e 753.766 cesáreas pelo SUS.
HUMANIZAÇÃO – A atenção humanizada ao parto e nascimento é fundamentada na importância do fortalecimento do protagonismo e da autonomia da mulher neste momento. Este modelo de parto incentiva a participação da gestante nas decisões referentes às condutas, protege a mulher contra violência ou negligência, reconhece os direitos fundamentais de mulheres e crianças a tecnologias apropriadas de atenção em saúde, com a adoção de práticas baseadas em evidências, e garante o direito à acompanhante de livre escolha.
Por Silvia Cavichioli, da Agência Saúde – Ascom/MS
(61) 3315-3580// 6260″
http://portalsaude.saude.gov.br/portalsaude/noticia/11182/162/saude-amplia-estrutura-para-realizar-partos-normais.html

Contrasts – Episode IV of the Series Birth Around the World

Next Sunday we will travel to the the extremes of the world and find out some more about the CONTRAST during child labor. On one hand we have countries with high technology and infrastructure and on the other hand we encounter with lack basic resources. U.S., Vietnam, Germany to Nepal we will see cultural diversity and public policies that lead us down to this different paths.
Birth the World!! Sunday, May 26 at 11:30pm on GNT

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“Diversity serves as a means by which we can learn and evolve” Birth Around the World

You can watch online in the link
You have to presss the full screen mode.

If you haven’t had the opportunity to watch the previous episodes, we have available online a piece of each one of the episodes! Hope you like it!!!

Birth Around The World – Episode III – Revolution

Revolution, our third episode will be on tv next sunday, May 19 11:30pm (brazilian time) at GNT. We have special interviews with the doctor and researcher Michel Odent, Ina May, Janet Balaskasand and Robin Lim! Passing by Indonesia, United States, England and New Zealand we’ll visit places that are living a revolution. Let’s see inspiring realities and who is behind them.

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“The importance of the revolution is to expand the opportunities available to women of how she wants to give birth to her baby” Birth Around the World

You can watch online in the link
You have to presss the full screen mode.

Parto Pelo Mundo – Birth Around The World – Episode: Transitions

The second program will be today, May 12 at 11:30pm, GNT (Brasil time).
Very special day because it is Mother’s Day and Nurse’s Day!

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In the next program we will travel to countries undergoing a transition, showing Nepal, Cambodia, Japan and Australia.. In which direction is heading this change?

“The world is in constant transition, and one of the most important in our lives is BIRTH” Birth Around the World

You can watch online in the link
You have to presss the full screen mode.

Birth Around the World Series premiere May 5th

It’s with great joy and excitement that we announce the premiere of Birth Around the World Series – “Parto pelo Mundo” on May 5th at 11pm on GNT!a local TV channel from Brazil!!
Produced by Cinevideo Produções

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Childbirth, anywhere in the world, is a remarkable event that deeply transforms the lives of all involved. An experience that is both common and distinct to all human beings in each and every society.

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The series “Parto pelo Mundo” (Birth Around the World) presents the many facets of birth through a journey around the world.

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Mayra Calvette, a nurse-midwife, and her husband, Enrico Ferrari, embarked on an adventurous journey, which lasted the period of a pregnancy, visiting 25 countries for over nine months.

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This new TV series is the result of this experience. It is an intimate, unique and personal record of various societies and how birth happens around the globe. Different points of view guided by the same concerns of a healthy, happy and safe birth for both mother and baby.

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The couple visited many dwellings and saw children being born in the middle of rice fields in Camboja, others being blessed by butter in Tibet, as well as many more being born in hospital with all the leading technology available today.

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They’ve interviewed physicians, nurses, midwives, doulas, fathers and mothers. Women who have revolutionized the health system in New Zealand and those who’ve decided to live in the margins of healthcare in the United States. Furthermore, they’ve investigated the big movement that is currently happening in their home country, Brazil.

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Visiting clinics, maternity homes, hospitals, villas and residences they’ve created a valuable memoir that displays the birth features of many nations. Interviews were recorded, vídeos, photos, and a travel journal were produced gathering important data of the healthcare system of each one of the country’s visited.

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This quest has been intertwined with common activities of a newlywed couple who travels the world experiencing different cultures, practicing sports and viewing unforgettable places of our planet.

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Mayra and Enrico are now back to their homeland to share this experience. “Parto pelo Mundo” is a new look at the world we live in by the way we’ve got into it.

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Join us, be inspired and part of this movement!

Together we are stronger!

The Big Tree

Stork Network – Towards a new model of care

Brazil is currently undergoing major changes in obstetric care. The movement for childbirth humanization is growing and getting stronger every day.

To give the necessary assistance to pregnant women and their children, the Ministry of Health launched in March 2011, the Stork Network strategy, composed of a set of measures to ensure all Brazilians, from the SUS (Brazilian public health system), adequate, safe and humane assistance from confirmation of pregnancy, through prenatal and childbirth, until the first two years of baby’s life. All Brazilian states have joined the Stork Network strategy.

The Stork Network, established under the National Public Health System, is a network of care that aims to ensure women’s right to reproductive planning and humanized assistance during pregnancy, childbirth, postpartum and abortion, as well for the child’s rights of a safe birth and healthy growth and development.

The Ministry of Health is investing $ 4,640 billion until 2014. These funds are invested in building a network care for women and children. “We have to build a welcoming environment for women to feel more secure at this time and, therefore, it is necessary to qualify the physical space and changing practices,” emphasizes the technical area coordinator of Women’s Health, Esther Vilela.

Prenatal care is a priority in the Basic Health Units (BHU). This is where the realization of all the care and prenatal testing happen. Also, at this time, the woman will make the link with maternity and will know, from the first months, where she will have her baby. Because what happens sometimes in Brazil is the lack of vacancies in public maternities, and the pregnant woman has to go from one place to another in labor.

During childbirth Stork Network qualifies health teams to provide humanized and skilled service. There’s a reception with risk classification, comfortable and safe environment for the woman and baby, focusing on quality and humanization of childbirth. A woman has the right to have a companion during labor and special assistance in the event of a high risk pregnancy. Furthermore, the strategy ensures humanized attention to women in an abortion situation. The Stork Network is funding 100% of the construction and funding of Birth Centers and House of the mother, baby and puerpera, 80% of funding for expansion and qualification of beds (ICU, Kangaroo care) and funding the ambience for delivery room in the hospitals, so they can be more welcoming and have “PPP” room (pre birth, birth and postpartum) for the woman in labor to stay in the same room during the process of giving birth.

During the postpartum, Stork Network accompanies the growth and development of children from 0-24 months of age. There is guidance on all necessary care for the woman and her baby, promoting breastfeeding and monitoring of the vaccination calendar. Additionally, moms can have access to information and availability of family planning methods, consultations and educational activities.

Let’s be part of this change! We must take the moment and the Federal Government investment! For this we need committed people who take this project forward so that the Stork Network strategy can be implemented in your city! The world is made of people, we need to make our part so the change can take place.

Bali – Living and Learning!

Bali is one of the Islands of Indonesia. It is known as the Island of Temples, Island of Peace Island of the Gods, Island of Hinduism, Island of Love. You can see the rich Balinese culture is already upon arrival at the airport, which is a typical construction. There are colors, music, spirituality, art and tradition everywhere in Bali!

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It has a population of about 3,891,000. Approximately 92% of the population is Hindu while in the other islands the vast majority is Muslim. And you don’t see violence around Bali.

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The traffic is crazy! Many motorbikes, horn all the time for anything, and small streets. But it seems that they understand each other!

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The first week I stayed in Ubud, one of the busiest cities of Bali, while Enrico was in Australia with his friend Eduardo Kiko (Dudu). The main reason was to be near Bumi Sehat clinic. This organization has the midwife Robin Lin as the founder.

I visited Bumi Sehat every day I was there. My idea was to do volunteer work there, but there were enough volunteers, working in several areas. And not many births happening that week, even with the full moon. So I was there observing the movement and talking with professionals, volunteers, midwives and mothers. You can read more about Bumi Sehat in the previous post.

Pre Natal Care education
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There I interviewed Ibu Robin Lin, Wine, Rena and Maya.

Robin is the founder of Bumi Sehat. She started to offer free care for pregnant women and children under five for free in 1994 in Ubud area. The demand grew and the clinic Bumi Sehat was founded in 1995. She is an exemple of compassion, love and determination.

Ibu Robin Lin with me!

Wine is a beautiful balinese women, she is also Robin’s daughter-in-law, married with her son. She had a lotus birth at home, with the help of Grandma Robin. She is pregnant again! Wine is also a teacher of yoga for pregnant women in the clinic.

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Maya is American and was working as a student volunteer, she told a little about her experience at the clinic so far.

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Rena is one of professional midwives at the clinic and is passionate about her work. She said the reality is very different in other hospitals in Bali and about the importance of loving care for the new mothers.

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This week I also met with Debra Pascali Bonaro , always smiling and radiating her wonderful light! She was there to give the course Doula Eat Pray that had women from all around the world participating. It was great to meet her again, talk and share about the travels around the world! I also had the opportunity to speak briefly about the project to the group.
Debra wearing the shirt of the project that and I with wearing Bumi Sehat shirt:

Debra Pascali and Bonaro me!

Besides visiting Bumi Sehat, I visited three clinics in Bali to know what happens at the other settings.

They are private clinics and have the government license to operate. The only public hospital is in Dempasar, so many women end up having their babies at the local clinics. Usually I come in and ask to speak to one of the nurses / midwives professionals.

When I have the opportunity I ask about birth for women, at the stores, restaurants, massage places, street. In one of the restaurants I went to lunch, the waitress was super friendly and had a very good English. She started talking about the planting of rice that was in front of the restaurant, which was the staple food and was always white. Many families have their own rice fields.
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The families are large. In Hindu culture when the woman marries she will live in her husband’s house, and add up the number of members at the house. But now the couples have less children. The schools are private and most health costs are also private.

The subject with the waitress ended up in Birth, as always … She said she has two daughters, ages 5 years and 2 years and that they stay with their grandmother while she works, which are every day, 8 hours per day. If she has a day off, she has to recover the other day … and the monthly salary is very low. She said she had her children in nurses clinic in her community. She said they exist it in many communities.
The next day we arranged to go visit this clinic together and she accept to be interviewed. She went to the clinic because the care is better and it’s closer from her house.

The other day she was there in front of my hotel with her daughter so we could visit the clinic together. On the way we talked about the Balinese culture and her conflicts in her second pregnancy.

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We arrived at the clinic, looked like a home from outside. And one of the nurses lives on top of the clinic. They do prenatal, delivery, and also family planning, vaccines and pediatric care. The nurse declined to be interviewed, and was also busy. So Tara showed me the clinic, which is a room for appointments and one behind for the birth. A small and simple room with two beds.

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I felt bad because her daughter was crying scared all the time we were there. She said it was because they normally go there for vaccinations. Might it be memories of the birth?

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Another clinic was in Nusa Dua. My friend Livia was with me. A very small clinic. The nurse showed the delivery room. A room with two beds for normal delivery. The nurse cares during labor, when gets near the time of birth, she calls the doctor.

There was a woman in labor with the support of her husband. I asked the nurse to ask them if I could get in. With their permission, I went. She was lying on the bed side. We started talking, but the husband was the one answering. It was her first baby. She said the contractions were hurting. Each rush (contraction) that came she would contract, but without doing any sound.

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I asked if the back was hurting. She said yes. I began to massage the lower back slowly, and she began to relax more. I said that moving the hips move could also help …. She wanted to try. She moved out of the bed and started moving the hip while I was doing massage. She seemed more relaxed. I thought it was time to go because I was just visiting and when I realized I was there helping a woman in labor … I miss doing that!

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I left, but soon I came back because I have forgotten to give my card with my email so I could send the photos. I came into the room and she was standing, moving the hips and her husband massaging the back! I was very happy to see that! She and her husband smiled at me and thanked me, saying it helped a lot!

I talked to the nurse and said that move, change positions, do massage during labor helps a lot! I suggested for her to visit Bumi Sehat in Ubud and see how the births take place there.. she seemed interested to learn.

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In Kuta I visited another clinic that is based in the care of nurses. It’s like a birth centre, where only normal deliveries take place, but without the philosophy of gentle birth. But it is well organized and clean.

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The nurse midwives Sukadani Ni Pt Ayu welcomed me and the clinic. There is a delivery room with two beds separated by a curtain. The deliveries always happen in the gynecological position as in the other clinics.

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The nurses did not know it could be different . If they need help in a complicated birth, they call the doctor, usually to use forceps or vacuum extraction during birth. The baby is born and taken to receive routine care. After, mother and baby go to the postpartum room together usually for two days. There is a private room and shared. The private sector is more expensive.

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I said : ” But you know that in my practice most mother chooses to have baby squatting!” , trying to not hurt them, but to say that there are other options… They looked to each other and gave and smiled, thinking it was a fun think to do: ” Oh, but here no, all women give birth laying down!” and they were proud of that, because it is more civilized!
But I said the other positions could help the baby descend, could facilitate … they demonstrated interest in learning more about it, they told me to come back to give a course.

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Most professionals and women simply do not know another way for babies to be born …the have been conditioned to think that this is the only and best way to do it. Maybe next time I come back ready to give courses?

This stayed in my mind … it would be another project!

Who knows, maybe in the future … Living and Learning!

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