The experience of being born that changes behaviors and beliefs about normal labor

The passage is dark and narrow. Even if you squirm and move gradually, at certain times, you feel that you will never be able to break through the obstacles in your way to reach the light that you can see in the distance. Still, you continue on. And finally, you leave that tight place for an immense place full of uncertainty. It is the external world. You were born.

More than 50,000 people experienced this process in three cities in Brazil by participating in the Senses of Birth (Sentidos do Nascer) Exhibition, designed by researchers Bernardo de Oliveira and Sonia Lansky, from the Federal University of Minas Gerais (UFMG). Between 2015 and 2019, the team set up 14 exhibitions in the cities of Belo Horizonte, Rio de Janeiro, Niterói, Ceilândia, and Brasília.

“Our intervention mixes art, science, and technology to change perceptions about birth, encouraging the appreciation of normal birth, the use of scientific evidence in childbirth care, and respect for the rights of women and children to reduce unnecessary cesarean sections and prematurity,” say the researchers. In 2018, 55 percent of childbirths in Brazil utilized surgical interventions, one of the highest rates in the world. According to the World Health Organization (WHO), caesarean sections are required in 10 to 15 percent of pregnancies for medical reasons. And 11.5 percent of the babies in these cases were born premature, a rate almost twice as high as recommended. Best practices in delivery and childbirth can impact maternal and child health and contribute to the reduction of maternal mortality and neonatal mortality, which are part of the UN Sustainable Development Goals for 2030.

The objective of the research was to scientifically measure the effect of the exposition on changing the perception, knowledge and behavior of participants – including pregnant women – to see if it is possible to transform it into a public health tool.

Among the 17,501 people who attended the exhibition in 2015 and answered a questionnaire on a totem at the end of it, there was a significant change in opinion about normal childbirth before and after the visit. The percentage of those who reported having a perception of normal delivery as “excellent” increased from 42.9 percent before the intervention to 82.7 percent after it. Approximately 75 percent of pregnant women changed their opinion about normal delivery: the positive perceptions of and preferences for it increased from 46 percent to 84 percent and from 79.5 percent to 83.4 percent, respectively. Knowledge about the best practices in care at childbirth, as recommended by WHO, increased by 61.3 percent among expectant mothers.

The project also conducted a follow-up survey with 650 pregnant women who participated in the exhibition and found that 42 percent had a cesarean section and 58 percent had a normal delivery – rates better than those of the Brazilian population (55 percent cesarean section and 45 percent normal delivery). They also found that the prematurity index, which was 7 percent, was well below the national average. “Another study by a doctoral student investigated the relationship between the participation of pregnant women in the exhibition Sentidos do Nascer and its influence on the woman’s decision on the type of delivery,” says Sônia. “We are also analyzing changes in perceptions and practices among 500 health professionals from the Unified Health System (SUS), who were trained for the project.”

Currently, the research group maintains a functional replica of the exhibition at Parque das Mangabeiras, in Belo Horizonte (MG), coupled with an extension course at the Federal University of Minas Gerais (UFMG), which is free and open to the community. It has drawn about 100 students per semester since 2016. “We want to take them to other places as an instrument for changing the culture around delivery and childbirth,” explains Bernardo. The estimated cost to install the exhibition is between 80 thousand reais for a fixed structure and 130 thousand reais for the itinerant exhibit, which moves to different cities and requires six to eight people per shift to run the experience. “We also have thought about taking the experience of being born to new technologies such as virtual reality, which could help to scale to this intervention,” say the experts.