Abstract: This article examines the knowledge and historical experiences of midwives based on literature published in the last ten years in articles found in the Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), and on the blog https://www.resenhacritica.com.br/. The aim is to take an inventory of the literature, quantify it, and describe the main contributions of experts on the historical knowledge and experiences of midwives.

Keywords: History of Midwifery, Knowledge of Birth, Literature Review.

Introduction

The connection between the knowledge and experience of midwives involves rescuing memories, values, techniques and rituals, supported by often empirical knowledge and altruism. This text lists the production, quantifies and elaborates a description of the knowledge and historical experiences of this group, based on the specialized literature on midwives in Brazilian academic journals of the 19th and 20th centuries. The research was carried out in the Virtual Health Library (BVS) and Scientific Electronic Library Online (SciELO) databases and on the blog https://www.resenhacritica.com.br/.

The first database, BVS, brings together more than 13,000 titles from national and international journals indexed in the main bibliographic indexes in the area of health. SciELO, on the other hand, works as a database that covers more than a thousand scientific journals and other academic publications, currently having around 600 thousand articles. The Blog Resenha Crítica provides monthly summaries of articles published in 213 Brazilian periodicals in the area of History. It is important to mention that only the summaries referring to the period from 2017 to 2022 are complete.

This review is the first task for the construction of research in the Graduate Program in African Studies, Indigenous Peoples and Black Cultures – PPGEAFIN at the State University of Bahia – UNEB. The provisional title of the study is “Remanescent Community of Quilombo Baixão de Zé Preto; Irecê, Bahia, Brazil: the popular knowledge of midwives in maternal care in the 1980s”.

All journal articles published between 2011 and 2021 that presented content relevant to the study objectives and that were available in full and free of charge were selected for this review. The searches were carried out between November and December 2022 using the descriptors: History, Midwives and Knowledge.

48 results were obtained, of which 35 were excluded: 12 due to inconsistency with the research problem, identified by the title; 6 for not addressing the research problem identified by the abstract; 8 for being duplicated; and 9 for dealing with the relationship between midwives and health services, obstetric nursing, the political struggle for humanized childbirth and the medicalization of childbirth. In the end, 13 articles were selected to compose the review sample. To this end, the method of identifying issues related to “knowledge”, defined as specific knowledge in a given area, and to “experiences”, understood as experiences that generated knowledge, was used. It is important to highlight that most of the selected texts were found in health and nursing journals, and few in history journals.

The results were divided into two topics: the first, “Historical experiences of midwives’ work”, addresses the basis of midwives’ care, based on empirical knowledge and experiences in caring for women in the pregnancy-puerperal cycle. In the second topic, “The knowledge of midwives during childbirth”, the techniques, practices and rituals related to the complexity that childbirth required are exposed, with attention directed towards the parturient woman and her family context.

Historical experiences of midwifery

The experience of midwives was discussed in 77% of the articles, mostly from the health area, especially nursing. From this set of texts, we obtained information mainly about definitions of midwives and the broad role played by them, which went beyond carrying out deliveries. Midwives were women without studies or specific training, whose knowledge was based on observation, the application of common sense and the oral exchange of popular practices. They had a sincere and collaborative attitude and were highly valued by the neighborhood, which classified them as good, decisive, willing, resourceful, clean, determined, courageous or prepared women. In addition to caring for women’s health during the pregnancy-puerperal cycle and the newborn, they also engaged in housework and in the field. Her knowledge was based on motherhood and observation.[1] These women became responsible for helping, welcoming and caring during pregnancy, delivery and postpartum, based on oral and gestural knowledge experienced and transmitted between generations.[2]

In Brazil, “traditional midwives” are women who provide home birth assistance, using popular knowledge and practices.[3] They are known by various names, such as “aparadeiras”, “comadres”, “cachimbeiras” and “lay midwives”,[4] and acquire their knowledge about parturition through orality and the exchange of experiences with other more experienced women, without recognized formal training.[5] The role of traditional Brazilian midwives was allowed in the country until the 1970s, and their temporal role varies according to the regions and sociodemographic characteristics of the population served.[6]

A study carried out in the state of Ceará, in northeastern Brazil, reports that midwives are known as “cachimbeiras”, in reference to one of the main rituals performed during labor. After smoking a pipe, the midwife would spit into her hands and rub the saliva on the woman’s abdomen, believing that this would speed up the delivery. After bathing the newborn, the midwife would inhale the smoke from the pipe and blow it into the child’s navel, in order to hasten the fall of the umbilical stump.

Research shows that midwives played a variety of roles in addition to delivering babies and caring for the mother and newborn. They examined wet nurses, took the children they helped bring into the world to the baptismal font, were summoned as experts in medico-legal examinations, issued health and illness certificates, performed bloodletting, applied vaccines, performed abortions and treated venereal diseases, irregular menstrual cycles, breastfeeding, sterility, rape, contraception, infertility and also offered children for adoption. In addition, they were counselors, performed massages, recommended and prepared home remedies for the treatment of colic, cough, gas and pain in general. Regarding care for pregnant women, the midwives accompanied the entire pregnancy period, taking care of the woman’s well-being and checking that the pregnancy was running smoothly.[7] It is important to highlight that, in addition to performing technical procedures during the monitoring of the pregnant woman, it was found that the midwife also provided emotional support, so that the pregnant woman could work better with the pain of labor and delivery.

According to Medeiros et al.,[8] although midwives were more common in the setting of births, there was no regular course for training midwives in Brazil until 1832. The training course for midwives was established by Article 19 of the law of October 3, 1832 (cited in Brasil, 1832), which determined that there should be a course for midwives given by the professor of childbirth. Childbirth care has undergone changes, but it is still a rite of passage for women and families. Before the institutionalization of childbirth, birth took place at home, involving family affection and without the intervention of health professionals.[9]

The knowledge of midwives at the time of childbirth

Of the selected articles, 77% focus on the experiences of midwives and 23% address their knowledge, mainly in the health area. In these 13 articles, data on the integration of midwives’ practices were identified, which gather knowledge acquired over time and based on the tradition of childbirth. In the historical context in which access to health services was not universal, midwives in the Brazilian semiarid region restructured and incorporated their knowledge to meet the social demand for care, especially in rural areas and among lower social classes.[10] Canassa et al.11i] point out that the work of midwives involves a set of practices and knowledge contextualized in their multiple social relationships. They highlight that, when traditional midwives were present in communities, learning was empirical, often transmitted by family members, friends, neighbors or other midwives. In contrast, midwives who worked in maternity wards were trained in the biomedical model and followed norms and routines imposed by it.

Performing a ritual that seeks to approach the sacred world is part of the practice of midwives during childbirth. This practice includes praying to patron saints, such as Nossa Senhora da Penha and Santa Margarida, massaging the woman’s belly with castor oil or a bottle of warm water to help the placenta detach, and providing the parturient woman with hot egg yolk or lard. mucura to drink, in order to avoid pain during childbirth. The midwives also reported receiving spiritual warnings that signaled whether the delivery assistance would be successful or not, influencing their decision-making process of monitoring during parturition. The testimonies collected by the midwives show that the delivery performed by them follows a ritual that seeks to approach the sacred world. Prayers, amulets and prohibitions are present during the preparation and delivery. Research shows important differences between deliveries performed by midwives and hospital deliveries, given that in the hospital environment technical and exclusively rational concerns predominate, while in deliveries performed by midwives, solidarity is prioritized. It is important to emphasize that the patron saint may vary according to the region. In the community of Itaqui-Bacanga, for example, the patron saints are Nossa Senhora da Penha and Santa Margarida.

Midwives used peppermint, black pepper and corn teas to help with parturition, increasing uterine contractions or preventing postpartum hemorrhage. To provide assistance and conduct parturition, they needed personal protective equipment and improvised according to their empirical knowledge.[12] Before giving birth, the ingestion of various teas complemented the ritual. After giving birth, another ritual began with a series of prohibitions and procedures to be followed by the “woman who gave birth”.

She had to stay secluded for seven days in her room to avoid “getting wind in her head”, eating only foods that were not considered unhealthy, such as bloodless chicken accompanied by a “dry flour” mush, not bathing and cleaning her bush bath, such as cotton, mastruz and mastic bark, to deflate the belly. In addition, she had to wrap her belly with a very tight band of fabric to help put the uterus in place, drink plenty of broth to produce milk for the child and maintain the “rest” period that lasts forty days. During this interval, the woman who gave birth was also exempt from housework.[13]

During the second stage, the midwives instructed the parturients about the most appropriate positions for childbirth, which could vary between lying down, squatting or standing, and about the right moment to do the abdominal pulls. This care alongside the parturients made them feel safer and encouraged to face labor with the midwives. As for the birth, the midwives described the immediate care of the newborn (NB), which included cutting the umbilical cord, body hygiene and mouth-to-mouth or mouth-to-nose aspiration, and when performing the latter, they washed their own mouths with cachaça.[14]

For the traditional midwives, the biggest concern during the assistance to the woman was the placental deliverance, due to the risk of hemorrhage and death. Therefore, they performed prayers and carefully observed the remnants of placental tissue. After the delivery assistance, the man of the house was responsible for burying the “delivery”. They also highlighted the importance of hygiene guidelines and home visits as part of postpartum care. Another important point in this period was the evolution of the umbilical stump, which was one of the main concerns of midwives during puerperal visits, which occurred between the third and eighth postpartum day. In addition, they pointed out that care related to the umbilical stump changed with the availability of alcohol and new knowledge.[15]

Conclusion

The objective of this study was to carry out an inventory of the literature, quantify it and describe the main contributions of specialists on the knowledge and historical experiences of midwives. The review included a sample of 13 articles. We observed that the midwives were experienced women and leaders, respected by the community, with low education, who became a reference for the health care of the parturient woman and the child. With regard to knowledge, midwives used medicinal plants during childbirth and the postpartum period, transmitted their knowledge between generations, encouraged parturients to overcome their fears and feel safe, recognized the importance of family and religious support, and used to say prayers during childbirth. delivery, evoking patron saints to ensure positive outcomes in the parturition and birth process.

Conclusion

Notes

[1] Diaz; González, 2016.

[2] Barbosa et. al; 2013; Castro, 2015.

[3] Gusman, 2015.

[4] Gomes, 2018.

[5] Norman; Tesser, 2015.

[6] Fabrizzio, 2019.

[7] Barreto, 2016.

[8] Medeiros et. al, 2018

[9] Diaz; González, 2016; Quitete, 2018.

[10] Gomes et al., 2918.

[11] Canassa et al., 2011.

[12] Gomes et al., 2021.

[13] Pereira, 2016.

[14] Gomes et al., 2021.

[15] Gomes et al., 2021.

References

BARBOSA, C. M.; SILVA, M. S.; CARICIO, M.R; MEDEIROS, A.P. Women and traditional midwives:  care practices during the process of labor and birth at home. Rev Pesq: Cuid Fundam Online. Rio de Janeiro, v.5, n.1, 2013.

BARRETO, Maria Renilda. Maternidade para escravas no Rio de Janeiro (1850-1889). Revista de História Regional. Ponta Grossa, v.21, n.2, p.389-406, 2016. Disponível em: http://www.revistas2.uepg.br/index.php/rhr

CANASSA, Neli Silvia Andreazzi et al. O saber/fazer das parteiras na Maternidade Carmela Dutra de Florianópolis – SC (1967/1994). Revista Brasileira de Enfermagem [online]. Floriaópolis, v. 64, n.3, p. 423-430, 2011. Acesso em: 4 Dezembro 2022],  Disponível em: <https://doi.org/10.1590/S0034-71672011000300003>.

CASTRO, C. M. [The meanings of planned home birth  for women from the municipality of Sao Paulo]. Cad Saúde Colet. Rio de Janeiro, v.23, n.1, p.69-75, 2015 .

DÍAZ, Elena Andina; GONZÁLEZ, José Siles. The domestic participation in birth assistance in the mid-twentieth century. Revista Latino-Americana de Enfermagem [online]. v.24, 2016. [Accessed 14 November 2022], e2727. Available from: <https://doi.org/10.1590/1518-8345.0574.2727>.

FABRIZZIO, C. G.; SCHMALFUSS, J. M.; SILVEIRA, L.; PEITER, C. C.; SANTOS, J. L. G.; ERDMANN, A. L. Obstetric practices of a midwife: contributions for the management of nursing care with the parturient. Rev. Enferm. Cent. O Min. Floriaópolis, v.9, 31892, 2019.

GOMES, S. C.; BRITO, N. S.; SILVA, N. E. F.; CAVALCANTE, E. G. R.; PINTO, A. G. A.; QUIRINO, G. S. Cuidados domiciliares de parteiras tradicionais na assistência ao parto. Rev. enferm. UERJ, Rio de Janeiro, 2021.

GOMES, Samara Calixto et al. História oral como método para a compreensão do ofício das parteiras do semiárido brasileiro. Texto & Contexto – Enfermagem [online]. Florianópolis, v. 27, n. 3, 2018. [Acessado 10 Novembro 2022], e2470017. Disponível em: <https://doi.org/10.1590/0104-07072018002470017>.

GUSMAN, C. R. ; VIANA, A. P. A. L.; MIRANDA, M. A. B.; PEDROSA, M. V.; VILLELA, W. V. Inclusion of traditional birth attendants in the public health care system in Brazil: reflecting on challenges. Rev. Panam. Salud Publica. Waschington, v. 37, n.4/5, p. 365-370, abr./mai., 2015.

MEDEIROS, Helber Renato Feydit de; CARVALHO, Diana Maul de; TURA, Luiz Fernando Rangel. A concorrência na arte de partejar na cidade do Rio de Janeiro entre 1835 e 1900. História, Ciências, Saúde – Manguinhos. Rio de Janeiro, v.25, n.4, out./dez., 2018.

NORMAN, A. H. Tesser CD. Midwives and obstetric nurses in the Brazilian Unified Health System and Primary Health Care: for a systemic and progressive incorporation. Rev. Bras. Med. Fam. Comunidade, Rio de Janeiro, v.10, n.32, p.1-7, 2015.

PEREIRA, Marina Santos. Associação das Parteiras Tradicionais do Maranhão: relato da assistência ao parto. Saúde Soc. São Paulo, v.25, n.3, 2016.

QUITETE, J. B.; MONTEIRO, J. A. M. B. Father’s participation in planned home birth: a meningful act for woman. Rev. Enferm UERJ. Rio de Janeiro, v.16, e18682, 2018.

To broaden your literature review

• See book reviews on
• Enfermagem
• História do parto
• Parto
• Consult dossiers of articles on
• Parteiras
• Parto| Partos

Reviewer

Taíse Santos Rocha – Master’s student in History (PPGEAFIN/UNEB). Nurse, Professor of the nursing course at Faculdade Irecê-FAI. She published, among other works, in co-authorship with Vanessa Juliana Almeida Reis and Adriele Pereira da Silva,  “Estratégias para captação de gestantes adolescentes às consultas de pré-natal ” e   “Assistência de enfermagem ao pré-natal: Relato de experiência in co-authorship with Gisele Gomes Dourado”. ID LATTES: https://lattes.cnpq.br/0947538744501443; ID ORCID: https://orcid.org/0000-0002-7895-8409. E-mail: [email protected]; Intagram: @taiserocha_enf.

To cite this review

ROCHA, Taíse Santos. Mothers of the Umbilicus: knowledge and historical experiences of midwives in Brazilian academic journals (19th and 20th centuries). Crítica Historiográfica. Natal, v.3, n.10, mar./apr., 2023. Disponível em <https://www.criticahistoriografica.com.br/revistas-ibero-americanas-de-historia-que-publicaram-entre-01-11-2023-e-31-12-2023/>. DOI: 10.29327/254374.3.10-13

© – Authors who publish in Historiographical Criticism agree to the distribution, remixing, adaptation and creation of their texts, even for commercial purposes, provided that due credit is guaranteed for the original creations. (CC BY-SA).

Crítica Historiográfica. Natal, v.3, n. 9, mar./apr., 2023 | ISSN 2764-2666