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| TUFH 40TH ANNIVERSARY SPECIAL PAPERS: PRACTICAL ADVICE PAPER |
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| Year : 2019 | Volume
: 32
| Issue : 3 | Page : 150-153 |
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A arte de nascer (The art of being born)
Carolina Araujo Damasio Santos1, Lilian Lira Lisboa1, Alexandra Nascimento Cassiano1, Alexandra Silva de Lima1, Reginaldo Antonio de Oliveira Freitas-Junior2
1 Anita Garibaldi Center for Education and Research in Health – Santos Dumont Institute, Macaíba-RN, Brazil
2 Anita Garibaldi Center for Education and Research in Health – Santos Dumont Institute, Macaíba-RN; Federal University of Rio Grande do Norte, Natal-RN, Brazil
| Date of Web Publication | 18-Apr-2020 |
Correspondence Address:
Carolina Araujo Damasio Santos
Anita Garibaldi Center for Education and Research in Health, Rod. RN-160, 2010, KM 1, 5 Distrito de Macaíba/RN, CEP: 59280-000
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/efh.EfH_260_19
In 2008, this project began with a small group of volunteers in a poor rural community in northeastern Brazil using art therapy to increase the knowledge of pregnant women about gestation, birth, and care of their babies. After positive results were seen within that community, the methodology was published as a book to be replicated in other states of Brazil. In 2010/2011, after being selected as a “Young Champions of Maternal Health” winner by Ashoka and Maternal Task Force competition, the project was adapted for the local culture in Mali and replicated in villages in West Africa with workshops using songs, poems, stories, crafts, and cinema. It continues to be implemented throughout Brazil, and since 2012, at the Institute Santos Dumont, a health, teaching, and research center in a rural area in Northeast Brazil. It is also used as a teaching strategy for students of medicine, physiotherapy, psychology, resident doctors, and multiprofessionals. It contributes to the development of attitudes, health education skills, and interprofessional education experience. It also provides information and educates groups to empower women about their health and rights to make informed choices regarding pregnancy and childbirth.
Keywords: Art therapy, health education, maternal health, medical education
How to cite this article:
Damasio Santos CA, Lisboa LL, Cassiano AN, de Lima AS, Oliveira Freitas-Junior RA. A arte de nascer (The art of being born). Educ Health 2019;32:150-3 |
| Background | |  |
Around the world, women continue to have a high risk of illness, injury, and death during pregnancy or childbirth. Despite numerous efforts, health systems often do not prioritize maternal health, and violations of women's rights are common. In Brazil, the promotion of gender equity and women's autonomy to avoid maternal mortality are still major challenges. High maternal mortality signals failures in obstetric care offered, from prenatal care to delivery. Although universal coverage of prenatal care and hospital care at delivery has been achieved, studies have shown failures in the quality of care provided. Lack of information and preventive measures contribute to these negative outcomes in relation to maternal and newborn health.[1] Furthermore, the pregnant women often experience disrespect and abuse during institutional birth besides unnecessary interventions, such as high rates of episiotomy, uterine fundal pressure, lithotomy position, and number of cesarean sections. National research on gender relations in 2010 showed that around 25% of women in labor were submitted to threats and verbal violence.[2] Consistent with results observed in other countries around the world, higher levels of maternal mortality happen in women from ethnic–racial minorities, rural areas, and lower socioeconomic levels.
Facing this scenario, several sectors have formulated proposals for change to contribute to the transformation of obstetric care in Brazil, including initiatives in the training of health professionals. One study analyzed the teaching of obstetrics, from the point of view of technical–scientific teaching and care/relationship with the patient, in two large medical schools in Brazil, finding the teaching of a pathological and medicalized view of the physiology of childbirth, teaching practice of conducts questioned by scientific evidence, and lack of sharing with the women of candidates or treatments adopted.[3]
Improving women's knowledge about their rights is an important strategy to confront and prevent institutional violence, but little attention is given to information and educational groups to empower women to make informed choices regarding pregnancy and childbirth.[4]
This project began with the goal of contributing to the improvement of maternal health through health promotion and prevention; stimulating healthy practices during pregnancy and maternal and child bonding; and empowering women about their rights during pregnancy, childbirth, and postpartum.
| Context | | |
In 2008, this project began with a small group of volunteers (including medical students) in a poor rural community in northeastern Brazil. The goal was to develop workshops and prenatal education groups using art therapy to increase the knowledge of pregnant women about gestation, birth, and care of their babies. After the 1st year of the program, the community and the volunteers realized how the groups were instilling good habits during pregnancy and newborn care, such as higher numbers of prenatal visits, more knowledge about delivery and care in postpartum, and a longer duration of breastfeeding. In 2010, the first book was released called, “The Art of Being Born-12 meetings for the formation of health in pregnant women.” It contained the design methodology to be replicated in different communities, by volunteers or community workers who wish to improve maternal and child health around Brazil.[5] After release of the book, the program started to be replicated in other states around Brazil.
In the same year, the project was one of the fifteen winners of the international competition “Young Champions of Maternal Health,” the first-ever international fellowship to focus specifically on supporting a new generation of global leaders, with research or field work, dedicated to improving maternal health, developed by the Maternal Task Force, partnered with ASHOKA and the Institute of International Education.[6] In 2010/2011, the project was adapted for the local culture and implemented in Mali, using songs, poems, stories, crafts, and cinema to support, empower, and educate young women and girls from rural villages in reproductive, maternal, and child health topics, named “L'Art de Naître.” The workshops included: The creation of theater plays on malaria prevention during and after pregnancy (one of the main causes of maternal and infant mortality) to present to the community; A “baya” (a set or necklace of pearls worn by African women as an ornament on their hips, which may have meanings like ornaments of seduction, protection or health) that helps count the menstrual cycle and to know the fertile days; a photography workshop with teenage singles with unplanned pregnancies and rejected by their families, as a way to stimulate bonding with the baby, rebuild self-esteem and promote mental health; workshops for traditional lullabies and storytelling for the baby; toy building workshop for baby with recyclable materials, etc., The program was adapted and implemented at local nongovernmental organization and volunteers were trained to replicate the project [Figure 1]. | Figure 1: Group of teenage moms during a painting activity in Koutiala, Mali
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| Activities (What Was Done) | | |
Currently, the “Arte de Nascer” program is offered to expectant mothers attending the Institute Santos Dumont, a health, teaching, and research center in a rural area in Macaiba/RN, in Northeast Brazil. It has also been used as a teaching strategy since 2014 for students of medicine, physiotherapy, psychology, and resident doctors and multiprofessional residents, contributing to the development of attitudes, health education skills, and interprofessional education experience.
Weekly meetings are held with the participation of preceptors, patients, residents, and health students, where soft technologies (music, painting, photography, crafts, videos, dance, etc.) and other active methodologies are used in workshops, assisting in the dissemination of information and increasing the bond between mothers and babies. Health topics such as violence against women, mental health, prevention of infections in pregnancy, care of the newborn, breastfeeding, preparation for childbirth, rights during pregnancy, and childbirth are part of the themes covered. From the workshop's development (1 week prior) and implementation, the students participate by assisting and contributing to the multiprofessional team. The participants evaluate the meetings at the end of each section and also can suggest topics for the next workshops. In 2017, 519 people participated in at least one workshop, including women and their partners, students, and health professionals [Figure 2].
In 2015, the program started being developed in conjunction with the Barriguda Project (projects that work 2018) in a Quilombola community in northeastern Brazil. “Quilombolas” are the descendants of enslaved Africans that maintain their ancestors' culture, livelihood, and religious traditions. They commonly live in rural areas with low availability of basic infrastructure and limited access to health care. A collective prenatal care service involving a multidisciplinary team and students from the Federal University of Rio Grande do Norte was implemented in Capoeiras dos Negros, in Macaíba-RN/Brazil, a community that includes approximately 300 families. The activities with the pregnant women included health education actions using soft technologies, group dynamics, relaxation techniques, artistic activities, and cultural activities. According to the team and medical students that participated in the Barriguda Project during the 1st year, the sections of the “Arte de Nascer” program were important to break the social barriers and existing cultural differences and promote the link between the community, professionals, and students.[7]
| Outcomes | | |
To identify the benefits for the students' and residents' participation in health education activities within the program, self-assessment data were collected using a survey about their perceptions on the development of their attitudes and skills. Forty-three students who participated in at least one meeting in 2017 or 2018 answered the survey. Ninety percent (39/43) students strongly agreed that the project helped them develop and enhance empathy and 88% answered the same for interprofessional education and 83% for communication skills. Furthermore, a word association test was performed, prompted by the following phrase: “Write the first five words or phrases that come to mind when thinking about your participation in health education activities with 'The Art of Being Born' program” [Figure 3].
| Future Directions | | |
The program has been a successful example promoting health education, promoting a space for discussion about health and rights and providing opportunities for building bonds between mother and baby, play activities, and taking care of mental health during pregnancy, contributing to the equity in women's lives and health. In addition, it can be adapted and replicated in different cultural and social settings, including neglected communities and in low-income settings.
It has also been shown to be an important strategy to change the teaching of health professionals in the work of prenatal care and childbirth in Brazil, because it can help students in the construction of skills such as empathy, teamwork, and humanization.
| Conclusions | | |
As strategies for coping with obstetric violence in Brazil, it is necessary to increase women's knowledge about their rights during prenatal care and childbirth[8] and empower them with knowledge regarding their body, gestation, and process from birth. More strengthened and supported, women can have a safe and respectful delivery, in the way they have planned and desired.
Involving the health students in the project activities and in similar workshops during their trainings in obstetrics can enhance their medical communication and improve doctor–patient relationships. They can experience the humanization of medical practice and develop skills to assist in project development, implementation, advocacy, and leadership. Furthermore, it may be a step to change the context of the current delivery model, where the technical model excels in rationality it lacks in humanization of assistance. Having the opportunity to stand beside women outside the office, to listen to their doubts and fears, to learn more about their lives, to learn in a painting class next to the patient, and to hear about the stories of obstetric violence suffered (including unnecessary procedures), can contribute to the reflection and consequent change of future professionals in the clinical practice scenarios.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Leal MD, Gama SG, Pereira AP, Pacheco VE, Carmo CN, Santos RV. The color of pain: Racial iniquities in prenatal care and childbirth in Brazil. Cad Saude Publica 2017;33 Suppl 1:e00078816.  |
| 2. | Grilo Diniz CS, Rattner D, Lucas d'Oliveira AF, de Aguiar JM, Niy DY. Disrespect and abuse in childbirth in Brazil: Social activism, public policies and providers' training. Reprod Health Matters 2018;26:19-35. |
| 3. | Hotimsky SN. Obstetric training: competence and care in birth assistance. Interface Comun Saúde Educ 2008;12:215. |
| 4. | Tesser CD, Knobel R, Andrezzo HF. Obstetric violence and quaternary prevention: What it is and what to do. Rev Bras Med Fam Comunidade 2015;10:1-2. |
| 5. | Santos CA. A Arte de Nascer-12 meetings for the formation of health in pregnant women.1st ed. Natal/RN: Self Published, 2010. p. 138. |
| 6. | Maternal Health Task Force. Young Champions of Maternal Health; 2009. Available from: https://www.mhtf.org/projects/ young-champions/. [Last accessed on 2019 Aug 21]. |
| 7. | Freitas RA Jr., Santos CA, Lisboa LL, Freitas Ana KM, Garcia VL, Azevedo GD. Incorporating Cultural Competence for Maternal Healthcare in the Quilombola Population into Health Profession Training. Rev Bras Educ Med 2018;42:100-9. Available from: http:// www.scielo.br/pdf/rbem/ v42n2/0100-5502-rbem-42-02-0100.pdf. [Last accessed 2019 Jun 21]. |
| 8. | Cleison R, Ferreira N. Institutional violence obstetric in Brazil: systematic review. Estação Científica (UNIFAP); 2014. p. 57-68. |
[Figure 1], [Figure 2], [Figure 3]
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