Participant

Considering the study setting, we present the paths taken, guided by the hands of the participant-guide Eva—a fictitious name representing the postpartum woman who shares her stories from her journey through living networks in search of humanized childbirth care. Her trajectory reveals the richness of what was produced through this encounter, confirming the potential of her role as a participant-guide and its value as a methodological strategy.

Eva was selected during the internal data validation phase of the Laboratório de Estudos e Pesquisas Qualitativas Interdisciplinares em Saúde [Laboratory of Interdisciplinary Qualitative Studies and Research in Health] (LabQuali).

Data Collection Instruments

Open-ended interviews were conducted using the following guiding questions: “Please tell me about your experience from the moment you found out you were pregnant until today,” “What is your perception of the care provided during labor and delivery in your experience?” “Did this perception have another meaning before?” and “What has the humanization movement meant to you in your experience?”

Data Procedures and Analysis

Three researchers participated in this phase, engaging in an interpretive process through readings and re-readings of the meanings produced by the effects of this encounter. Based on Eva’s recorded account from November 19, 2019, we were able to trace the paths taken by the participant-guide, allowing us to delve into each meaning of her story in the construction of a humanized care pathway during her labor and childbirth process. We began to problematize these issues during meetings of the LabQuali research group, aiming to activate and follow these networks while remaining open to demands beyond our own. Thus, we embarked on a pilgrimage, mapping Eva’s paths in search of humanized care and systematizing them through the construction of a descriptive flowchart that analyzes production processes in the form of a graphic representation (^{Rodrigues et al., 2019}). This flowchart was designed based on Eva’s pilgrimage in search of a humanized care pathway, allowing us to identify the network she traveled—not only through the formal healthcare system, but also through the alternative networks she produced along her journey.

Next, discourse analysis was conducted by exploring the material through multiple readings of the interview to become familiar with the lived experience and to interpret the narrative.

The reflections presented a stem from a section of a larger investigation, “(Res)significando o parto: uma análise cartográfica da vivência de mulheres e profissionais de saúde” [(Re)signifying Childbirth: A Cartographic Analysis of the Experience of Women and Healthcare Professionals], which fully complied with Resolutions 466/12 and 510/16 of the Brazilian National Health Council. The study was approved by the Institutional Review Board under the corresponding opinion and CAAE: 16210619.3.0000.5146. Additionally, the participant confirmed her consent by signing a free and informed consent form.

Who Is Eva? A healthcare service user who is the protagonist of her own care

Eva is a 29-year-old woman with a bachelor’s degree, married, and living in Montes Claros, Minas Gerais, Brazil. She was nine days postpartum following the birth of her first child, who was born at term (40 weeks and 1 day). Eva attended 11 prenatal consultations in the private healthcare sector throughout her pregnancy, which progressed without complications. She was assisted by a multidisciplinary team during the progression of her labor and delivery, with the birth ultimately attended by the obstetrician of her choice.

The flowchart presented in Figure 1 provides a visual representation of the steps involved in the humanization of childbirth. Pregnancy, represented by an ellipse, is highlighted as the entry point into this process, marking the beginning of a trajectory that culminates in a humanized birth. From this starting point, Eva finds herself at a decision-making moment regarding humanized childbirth, represented by a rhombus, as she continues her search for this line of care. Information obtained through a support network and recommendations of professionals aligned with this perspective – represented by rectangles – allows for the demystification of childbirth beyond popular beliefs, leading to a new decision point, again represented by a rhombus. This path leads to Eva and her partner’s firm commitment to humanized childbirth, an intervention process depicted by a rectangle, which fosters a sense of safety, confidence, tranquility, and practical experience, ultimately redefining her care experience. Female empowerment, represented by an ellipse, marks the exit point of this process.

Source: Developed by the authors, 2022.

Figure 1 Participant-guide descriptor flowchart Eva. 

Creating spaces for protagonism in the experience of humanized care

Eva discovered she was pregnant with Adam in February 2019. At the time, she and her partner were living in another state due to their jobs as civil servants. From that moment, the couple expressed a desire for a natural childbirth and began seeking information, initially drawing on their family experiences.

First, I learned about it from a cousin who was pregnant in the middle of last year. She would often talk to me, share her experiences, and tell me about everything she was doing—her research, everything. She was the person who most encouraged me to pursue this line of thinking, to research more about it, and she recommended that I watch the documentary O Renascimento do Parto [The Rebirth of Childbirth]. That was when I began to develop a deeper, more effective awareness of the humanized childbirth movement (EVA).

Following Eva’s lead, we observe the positive role of social and literary media as territories that can contribute to legitimizing this type of care process.

After I watched the documentary, I started looking for information on the Internet and in books. I then came across more technical books that helped me understand the process better, and I became increasingly convinced about choosing humanized childbirth, which practically became a necessity as I continued reading and studying. Humanized childbirth is part of an entire process, undertaken by the woman, the family, the partner, and the team that supports her (EVA).

Humanization brings this empowerment through knowledge, allowing you to say, ‘Oh, this is how it is because of this, this, and this.’ So, for example, there is no reason for a C-section in a given case if it is not truly justified. I think you start to have greater command over what childbirth is and what the entire process involves. I believe you need knowledge to have the confidence and courage to make this choice with conviction – to turn this choice into a firm decision (EVA).

Thus, as we identified the markers of her journey throughout pregnancy in search of information, reflections emerged during this pilgrimage, particularly regarding the role of the father, as it represents unfamiliar territory for men.

The logic of childbirth – natural childbirth, the whole issue of humanization – I think for men, for fathers, happens differently, especially because the changes for them are more gradual. So yes, the courses we attended helped a lot with this process of reflection, both for the father and for both of us, but mainly they created a space for the couple – a moment for the couple to rethink the changes and to reflect on what life would be like afterward (EVA).

The knowledge needed to provide safe and quality care accompanied Eva throughout her pregnancy. The experiences of other service users were important in encouraging her to seek information and to find professionals who shared the vision of humanized labor and childbirth in providing her care.

I looked for medical recommendations through a group of mothers in Curitiba, and they recommended a doula to me. This doula then gave me recommendations of doctors. I felt more at ease because a recommendation coming from the doula meant there was a good chance the doctor would truly follow the humanized childbirth model (EVA).

I tried to connect with professionals who also shared this perspective of childbirth (EVA).

This humanized perspective among the healthcare professionals helped Eva to feel even safer and more confident about the labor and birth process.

Trusting the team helped reassure me that labor would be smooth and safe (EVA).

By continuing to follow the care pathway traced by Eva, we began to recognize the importance of the knowledge she acquired about humanized childbirth.

Childbirth used to be associated with suffering, pain, and a very difficult postpartum period. So the view I had long before—even before thinking about having children – was shaped by this perspective (EVA).

There were many situations in which only the negative side was talked about and reported (EVA).

However, we also observe that her narrative conveys detailed impressions shaped by previous perceptions rooted in popular beliefs, in which humanized childbirth was seen as an abstract process – lacking scientific basis, support, and relevance to our reality.

I thought it was something more abstract and, at the same time, lacked clear criteria. So the impression I had was that it was something unusual in Brazil – something I associated more with the United States or Europe. I thought it was related to home birth, which is not necessarily true (EVA).

So, people in general think that humanized childbirth is unassisted, something done without criteria, as if it were an idea for people who are, I don’t know, more detached or alternative—people who want to give birth at home or in water, in a bathtub (EVA).

The power of humanized care: networks that weave bonds and empower women.

Eva’s narrative allowed us to identify the plane of forms of humanized care, influenced by the plane of forces established through flexible, hard, and lines of flight, forming a living network in its multiplicity and constant assemblage. Accordingly, we present the rhizomatic aspect of humanized care, represented in Figure 2.

Source: Developed by the authors, 2022.

Figure 2 Rhizomated humanized care. 

The flexible lines were produced through Eva’s encounters with healthcare professionals in both home and hospital settings, representing light care technologies applied through good childbirth care practices, which allowed her to have a practical experience with humanized childbirth. These lines emphasized the formation of bonds, welcoming, clarification regarding childbirth care, and the protagonism of the participant-guide even before birth, with the doula playing an integral role in the production of humanized care along her line of flight.

One day, I made the birth plan with the doula. In the birth plan, we basically defined aspects related to the moment of birth, deciding who we wanted to be present, how the procedures would be carried out, who would clamp the cord, and what the first care for the baby would be. We discussed all of this, and it was great because I think it’s the moment when you really reflect on the circumstances. Even though the entire prenatal period is focused on preparing for this moment, sometimes you don’t have the time – because of the rush, for many reasons – to truly reflect on the birth and how you want it to happen. Even though we know there can be variations and that some interventions may be necessary, it’s important to think about your wishes for that moment. So, it was really good (EVA).

It was me, my partner, and the doula. We were discussing the birth plan – some details that we sometimes don’t even think about, but that are important to flow well in the moment (EVA).

Following the childbirth care protocol, Eva began labor induction on November 10, 2019, consistent with the circumstances at that moment. Care was provided in the hospital setting, always supported by a team that promoted evidence-based care throughout the progression of her labor and delivery, without losing sight of her protagonism. This approach helped reshape the scenario through woman-centered care and the use of available technologies in a less interventionist and more humanized manner (^{Rocha & Ferreira, 2020}).

We chose to induce labor with misoprostol to see how my body would respond to the induction. Misoprostol was inserted intravaginally, and after about an hour or so, we started activities to stimulate the onset of labor. We did exercises on the ball, danced, and walked. What stood out to me the most at that moment was how easy and calm the process felt. Everything that was done – the entire procedure and everything that was about to happen – was always explained to us by the team (EVA).

The expulsive period was very long – it lasted almost three hours—but the same approach, the same logic, was maintained. I changed positions, and my choices were respected at all times. The obstetric nurse, the doula, and the obstetrician suggested different positions to help me feel more comfortable and to stimulate the phase I was in [the expulsive period]. I tried three or four positions, and finally, the obstetrician suggested that I stand on the bed, hold onto the bar. I remembered that when I had tried squatting while holding the bar before, it had felt more comfortable than using the stool or other positions I had tried earlier. And again, I felt greater comfort in that position (EVA).

The pain of childbirth, in its rhizomatic aspect, represents a line of flight for many women who ultimately undergo surgical delivery. However, it can be traversed by the flexible lines of good childbirth care practices, including non-pharmacological methods of pain relief – practices that were skillfully conducted, particularly by obstetric nurses, and experienced by Eva.

At first, I felt pain similar to cramps – a very manageable situation – and I was still able to talk, dance, and behave normally. As the contractions intensified, it was as if I entered my own space, where only I could fit [laughs], and in that sense, labor progressed, and it was good that way. As the pain increased, I was able to cope with it. It became stronger, but at the same time, I was prepared for it, so I started feeling it more gradually (EVA).

What helped a lot during the progression of labor, and even during the pain of the contractions, was the team constantly giving massages, offering support, and holding me. Sometimes they would hug me or help me change positions, and my choices were always respected. At one moment, I was on the ball; at another, I was in bed; then later, I was in the shower. Everything had a purpose – it was something I could feel, something that made me more comfortable in that moment, and from there, we would adjust as needed (EVA).

Although this care is recorded from the participant’s perspective, maternal physical exhaustion was noticeable as a hard line, even as it was crossed by the flexible lines of confidence and tranquility leading up to the culmination of birth.

I became more confident; I thought, ‘Wow, it’s already very close.’ So, the worst is over [laughs], we’ve already progressed well. But at the same time that it gave me all this confidence, I started to feel that I was so close, and I think that brought a kind of excessive calmness, mixed with the tiredness of thinking I was so close—so close—that I lost heart (EVA).

However, these hard lines related to the emotional aspects and the duration of labor progression, which crossed the participant-guide’s experience, did not diminish the beauty of the moment when her healthy child was born, nor the bond established between the newborn and the family, supported by the healthcare team.

The moment he was born – today I was even trying to describe this to someone – is hard to put into words because it is a moment of enormous emotion, a really powerful feeling toward the baby and everything that is to come. At the same time, it is an intimate feeling; it brings joy, immense happiness, and the thought of how healthy this is for our child. How wonderful it is, how healthy it is for him (EVA).

The team encouraged physical contact, so the baby could stay with his father and me. He stayed on my lap, and only afterward was the first care provided. Only the necessary care was performed – nothing that would harm the baby’s health or was done merely out of protocol – and that’s wonderful! Realizing that the team, as a whole, respects you and sees that process as something unique is incredible (EVA).

The most remarkable aspect of Eva’s journey is her countless experiences throughout the care provided during labor. Her narrative reaffirms the practical experience of humanized childbirth, marking a singular and unique moment of female empowerment.

The experience is unique. It is special for each person and unique to each person. You should never compare yourself or try to find a standard in someone else, because labor basically depends on you and on the team assisting and providing care. So there will never be one experience exactly like another, you know (EVA).

Humanization is closely tied to feminism itself—to valuing women, to recognizing women as a force, as beings who act, think, produce, and seek. I believe that humanization, in general, brings all of this, and above all, it brings two things: knowledge and courage (EVA).