Etnográfica
Revista do Centro em Rede de Investigação em
Antropologia
vol. 22 (3) | 2018
Inclui dossiê "Birthing matters in Portugal:
anthropological explorations"
Birthing matters in Portugal: introduction
A importância do parto em Portugal: introdução
Anna Fedele and Joanna White
Electronic version
URL: http://journals.openedition.org/etnografica/5951
ISSN: 2182-2891
Publisher
Centro em Rede de Investigação em Antropologia
Printed version
Date of publication: 1 October 2018
Number of pages: 607-618
ISSN: 0873-6561
Electronic reference
Anna Fedele and Joanna White, « Birthing matters in Portugal: introduction », Etnográfica [Online], vol.
22 (3) | 2018, Online since 10 October 2018, connection on 13 October 2018. URL : http://
journals.openedition.org/etnografica/5951
Etnográfica is licensed under a Creative Commons Attribution-NonCommercial 4.0 International
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etnográfica
outubro de 2018
22 (3): 607-618
Birthing matters in Portugal:
introduction
Anna Fedele and Joanna White
In this introduction to the collection “Birthing matters in Portugal,” the contributions of anthropology to the understanding of childbirth as social practice are
outlined. Portugal is a country with one of the highest rates of medical intervention
in childbirth in Europe, and widespread and diverse opposition to current medicalised approaches to birthing care in Portugal are becoming increasingly visible,
yet the “alternative” practice of homebirth exists in a legal void. The introduction
provides a summary of the historical emergence of the current situation, which has
scarcely been explored to date by social science scholars. This colelction of articles
is an attempt to bridge the present gap in knowledge by showcasing new anthropological research from Portugal on pregnancy and childbirth, offering analyses of
birth which go beyond generalising descriptions of the oppositional discourses of
specific social actors (e. g. doctors, midwives, homebirthers), and instead analyse
the various reflections, collaborations, contestations and contradictions, in particular situations and settings. The experiences of women are foregrounded. The
contribution of each of the four papers in the collection is described.
KEYWORDS: childbirth, medicalization, anthropology, Portugal, homebirth, preg-
nancy.
A importância do parto em Portugal: introdução Nesta introdução ao dossier “A importância do parto em Portugal” são apresentadas as contribuições da
antropologia para a compreensão do parto como prática social. Portugal apresenta
uma das taxas mais altas da Europa de intervenção médica no parto, e uma ampla
e diversificada oposição às atuais abordagens medicalizadas do parto em Portugal
está a tornar-se cada vez mais visível; no entanto, a prática “alternativa” do parto
domiciliar existe num vazio legal. Esta introdução fornece um resumo histórico da
forma como a situação atual surgiu, o que até agora praticamente não foi explorado
nas ciências sociais. O dossiê é uma tentativa de colmatar a atual lacuna no conhecimento, apresentando novas pesquisas antropológicas sobre gravidez e parto em
Portugal, as quais oferecem novas análises que vão além da descrição generalizada
dos discursos de oposição de atores sociais específicos (por exemplo, médicos, parteiras, pessoas que experienciaram partos domiciliares) e, em vez disso, analisam as
várias reflexões, colaborações, contestações e contradições que emergem em situações e contextos particulares e, em especial, pondo a experiência das mulheres em
primeiro plano.
PALAVRAS-CHAVE: parto, medicalização, antropologia, Portugal, parto domiciliar,
gravidez.
FEDELE, Anna (fedele.anna@gmail.com) – Centro em Rede de Investigação em
Antropologia, ISCTE – Instituto Universitário de Lisboa (CRIA-IUL), Portugal.
WHITE, Joanna (jowhite67@yahoo.co.uk) – University of the West of England, UK.
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PORTUGAL CURRENTLY HAS THE SECOND HIGHEST REPORTED RATE OF
medicalised birth in Europe, based on combined data of rates of caesarean
section (C-section) and vaginal instrumental birth (EPP 2013, reporting data
from 2010).1 Available data reveal, moreover, the C-section rate to be consistently amongst the highest in Europe (EPP 2013), and part of a concerning
trend regarding increasing C-section rates worldwide (WHO 2015). Indeed,
the World Health Organization (WHO) criticized the lack of standards for
acceptable C-section rates in the country (WHO 2010). Episiotomy rates for
vaginal birth stand at 72.9% (EPP 2013). Systematic national data on certain
elements of medicalised birth, such as the use of epidural in vaginal birth,
induction of labour, the invasive procedure of artificially rupturing the membranes (the toque) and other procedures, such as the Kristeller manoeuvre, are
not systematically collected. However, the rates of these interventions, though
variable amongst different professional teams and health institutions, are also
reported to be high.2 Some of these procedures are extremely controversial and
associated with negative outcomes.3
Widespread and diverse opposition to current, medicalised approaches
to birthing care in Portugal has become increasingly visible. Women’s negative experiences of medicalised approaches have prompted a movement
for “humanizing” birth and empowering women, based on an adaptation of
international approaches (Akrich et al. 2014; APDMGP 2015). The Portuguese
Association for the Humanization of Childbirth (Associação Portuguesa pela
Humanização do Parto – Humpar), active since 2005, and the more recently
created Portuguese Association for the Rights of Women in Pregnancy and
Childbirth (Associação Portuguesa pelos Direitos da Mulher na Gravidez e
Parto – APDMGP) advocate new approaches to birthing more focused on women’s needs and rights (White and Schouten 2014; Akrich et al. 2014; APDMGP
1
We would like to thank CRIA and CIES for supporting the series of film screenings and discussions
on birth which took place at the University Institute of Lisbon (Instituto Universitário de Lisboa,
ISCTE-IUL) between September 2014 and March 2015. We are particularly grateful to Antónia Lima,
Manuela Cunha, Mário Santos, Maria Schouten and Mafalda Melo Sousa for their support and collaboration. All of the research presented in this dossier was made possible by funding from the Portuguese Foundation for Science and Technology (FCT): that of Francesca de Luca through a doctoral
grant (SFRH/BD/93020/2013), that of Joanna White and Filipa Queirós through support as part of the
EU Marie Curie Welcome II Programme (Welcome II/119/CRIA/1007/2011) and a scholarship as invited scientist (Joanna White, SFRH/BCC/52703/2014), that of Elizabeth Challinor within the strategic
plan of CRIA (UID/ANT/04038/2013), and that of Anna Fedele as part of the same strategic plan (UID/
ANT/04038/2013), and as part of her activities as a postdoctoral researcher (SFRH/BPD/47864/2008)
and later as FCT researcher (IF/01063/2014).
2
Personal communications from medical professionals working in a range of hospital settings in
Portugal.
3
In relation to the toque, see, for example, RCM (2012); in relation to the Kristeller manoeuvre, see,
for example, Matsuo et al. (2009) and Fedele, this volume.
BIRTHING MATTERS IN PORTUGAL: INTRODUCTION
609
2015). Moreover, the phenomenon whereby some women decide to bypass
available health services and give birth at home can be understood as a reaction to and rejection of the birthing options available within existing health
services. Midwife-led qualitative studies have critiqued the dominant mode
of hospital birth and called for a more “respectful” approach (see, for example, Ramalho 2011) and there have also been health policy-maker and practitioner-led initiatives directly aimed at reducing medical intervention rates (OE/
APEO 2012; Ayres-de-Campos et al. 2015). Any consequent transformation in
medical practice appears to be slow-moving, however.
The historical developments, discourses and institutional practices contributing to the present situation have scarcely been explored by social science scholars, nor have women’s experiences of medicalised (or alternative)
approaches to childbirth been scrutinized. This special issue is an attempt
to bridge the present gap in knowledge by showcasing new anthropological
research from Portugal on pregnancy and childbirth. It represents a first step
that will hopefully encourage further ethnographic as well as inter-disciplinary
research in this direction.
Anthropology has made important contributions to the understanding of
the social practices associated with reproduction since the pioneering work of
Margaret Mead in the early decades of the twentieth century (Mead 1930).
Several decades later, Brigitte Jordan’s seminal cross-cultural scholarship (1993
[1978]) not only highlighted the locally-specific shaping of the universal physiology of birth, but established childbirth as a legitimate area of ethnographic
enquiry, giving rise to the “anthropology of birth,” which has had an important
impact on social science study and childbirth activism alike (Oakley 2016).
One of Jordan’s most crucial contributions was her delineation of “authoritative knowledge,” whereby certain knowledge forms associated with birth
are socially sanctioned and privileged and accepted as grounds for legitimate
interference, with different actors engaged in their routine production and
reproduction. While different forms of knowledge may co-exist in any particular domain, some may gain ascendance and greater legitimacy than others
because they apparently explain the world better for the purposes at hand, or
are associated with a stronger power base (Jordan 1993 [1978]). In many situations multiple – sometimes competing – forms of knowledge are present by
virtue of the status, experience and background of different participants in the
birthing process. In this context of competing discourses, those who espouse
“alternative” systems can often be labelled as backward, ignorant, naive, troublemakers (Jordan 1989, 1992).
Subsequent scholarship has provided important new empirical and theoretical contributions, often applying cross-cultural comparisons to elucidate
the mechanisms of power and authority associated with pregnancy and birthing, and the increasing application of technology (Jordan 1992; Davis-Floyd
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and Sargent 1997; Kornelsen 2005). Such analyses have consistently demonstrated how the management of birth in any given setting is indicative of core
or normative values.
Women’s reported experiences during pregnancy and birth, and the attributes of women’s agency, have become the focus of more recent studies,
informed by feminist perspectives. It has been shown, for example, how childbirth education courses during the ante-natal period can constitute both a legitimization of the authoritative knowledge associated with medicalised birthing
practices, but also a forum for challenging the authority of biomedicine, as
women share and valorise their experiential knowledge (Ketler 2000). Martin
(2003) emphasised the role of an internalised sense of gender amongst women
in the disciplining of their selves and bodies during birth, while Tanassi (2004)
delineated the strategic value of women’s agency and behaviour in institutionalised settings and its contribution to the lived reality of birth. Akrich and
Pasveer (2004) covered new ground in their analysis of the complex forms of
embodiment experienced by women in the birthing process.
All of this existing body of work is clearly relevant to every cultural setting, yet the anthropological study of pregnancy and childbirth in Portugal to
date remains extremely limited. Published work has focused on the material
culture of traditional homebirthing (Ribeiro 1990) and the social function of
midwives in supporting women during the emotionally as well as physically
intense moment of birth (Joaquim 1983). In Joaquim’s text, based on research
conducted in the early 1980s, pain emerges as an essential element of a woman’s life (see also De Luca, this volume). Joaquim observed that experiencing
the pain of birth has emerged as a sort of initiatory test (prova iniciática) which
women must pass in order to become a mother.4 The relatively recent widespread emergence of the epidural anaesthetic to manage women’s labour pain,
an intervention widely used in Portugal, adds new complexity to (historical)
discourses on pain, which have, up to now, been little explored by researchers
(but see De Luca, and White and Queirós, this volume).
A recent two-country ethnographic study of both Portugal and England
(White 2016) built upon scholarship on temporality and birth (McCourt
2009), examining the different ways in which women absorbed and resisted
the institutionalised structuring of time imposed upon them during pregnancy
and childbirth, while also concluding that less agency was evidenced amongst
women in the Portuguese context. Fedele has analysed the experiences of what
she describes as holistic mothers, women who choose alternative ways of birthing and mothering because they consider pregnancy, birth and early childhood
as important moments for the spiritual and psychological development of
4
See also Joaquim (2006) for an analysis of motherhood in Portugal and a discussion of the public
maternity health sector in Portugal.
BIRTHING MATTERS IN PORTUGAL: INTRODUCTION
611
mother and child. Fedele has shown how holistic mothers challenge biomedical models of the body and ask for a more women-centred care in Portugal
(Fedele 2016; Fedele and Pasche Guignard 2018). Within broader social science research, homebirth has been examined as social practice (Santos 2012).
As feminist scholars and mothers who have devoted some years to the
anthropological study of childbirth in Portugal, we consider it vital that emerging academic work in this area enters the public domain to inform ongoing
debates. The papers in this dossier are based on presentations at a symposium
entitled “Pregnancy and childbirth reframed: anthropological perspectives
from Portugal,” which took place in June 2015 at the Centre for Research in
Anthropology (CRIA) of the University Institute of Lisbon (Instituto Universitário de Lisboa, ISCTE-IUL). CRIA first facilitated academic and public debate on
birthing in Portugal through the hosting of a Lisbon seminar in 2013 (White
and Schouten 2014). At this event, the intense interest in the cultural, social
and gendered meanings of discourses and practices related to childbirth, and
the outcome for women of current, medicalised approaches became apparent.
This interest was evident not only amongst social scientists, but also midwives,
doulas and the wider public.5 The documentary film cycle on childbirth which
CRIA and the Centre for Research and Studies in Sociology (CIES) of ISCTE-IUL
co-hosted between September 2014 and March 2015 confirmed this interest.
At post-screening discussions, academics, medical professionals and women
debated and shared experiences, at what were often very “charged” events,
particularly when, on occasion, Portuguese women recounted the traumatic
impacts which medicalised birth had had upon them. In a more recent development, CIES-IUL hosted a multi-disciplinary international conference on
childbirth, “From birth to health: towards sustainable childbirth,” in September 2018.
Through the work presented in the current collection of papers we endeavour
to situate (or re-position) women in the centre of our deliberations on childbirth.
A diverse range of narratives are presented in the various papers, revealing
women’s agency in myriad forms. Both the historical process of knowledge production and contemporarily situated “authoritative knowledge,” which influence current discourses and behaviour, are delineated. The papers selected for
this collection reveal how, in different circumstances, personal, spiritual and
also medical professional rhetoric can influence and underpin women’s thinking and behaviour in relation to their pregnancy and birthing; women’s critical
capacity emerges as a key theme in a number of the papers included. The
collection includes examples of different childbirth practices and their com-
5
A doula is a person without medical specialisation who assists a woman and her close family
before, during and after childbirth (regarding the role of doulas in Portugal, see also Fedele, in this
volume).
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plexities. It further provides evidence of how women’s decisions and actions
which challenge prevailing convention, and can be understood as threatening
the current balance of power, are frequently not supported, and in some cases
are directly opposed. Such responses contravene the concept of women-centred care, in other words, women’s right to be fully supported in making an
informed and personal choice regarding their method of birthing, without feeling discriminated against or harshly judged; a concept which we fully endorse.
Francesca De Luca’s article opens our collection because it traces the foundations of biomedical discourses and practices in Portugal, furthering understanding of the contemporary aspects of childbirth which are at the centre of
the papers which follow. The author explores the pain of labour in childbirth
from its first appearance in Portuguese obstetric literature between the mid19th and early 20th century, through an analysis of biomedical and others texts.
This historical approach allows us to observe the changing meanings attributed
by biomedical discourse to the pain of labour and women’s labouring bodies.
Thanks to De Luca’s fine-grained analysis, we can see how the political, emotional and gendered struggles to define and circumscribe the pain of labour
are not only a contemporary phenomenon but represent an ongoing process.
Debates and practices around pain oscillate between two extremes: on the one
side, there are the biomedical efforts to eliminate pain, considering it as useless
(see also White and Queirós, this volume), even cruel, a punishment given
by the Judeo-Christian God to punish women for the fall of Eve (Pina-Cabral
1986); on the other side, “alternative” approaches to birth emphasise its positive contribution to physiological birth, and its potentially transformative and
empowering effects for women. Common to all these discourses, however, is
the quest for a positive experience of birth.
De Luca’s paper alludes to how, in the historical Catholic reality of childbirth in Portugal, pain can be seen to have represented a specifically gendered
means of expiating sin, in the context of what de Luca described as a life
“vowed to sacrifice”. This scenario radically changed with the development
of anaesthetic practices during the 19th century. Gradually, the elimination
of pain became a moral duty for the Portuguese obstetricians who, following
Hippocrates motto divinum est opus sedare dolorem, assumed a God-like role,
employing different forms of anaesthesia. Pain thereby appeared as a “disembodied, ontological phenomenon” to be separated from the birthing process in
a context in which the necessity of delivering women from suffering became
the foundation of modern obstetrics in Portugal.
Focusing on the contrasting interpretations of childbirth amongst obstetricians and midwives in Portugal, Joanna White and Filipa Queirós demonstrate
how the avoidance of pain through anaesthetic pain relief and/or procedures
and methods of intervention in labour and birth to speed up the process still
remain at the centre of the contemporary biomedical discourse largely shared
BIRTHING MATTERS IN PORTUGAL: INTRODUCTION
613
by obstetricians. This approach contrasts with that of midwives, who generally
focus their efforts on a minimization of medical intervention according to a
model of “normal birth” in which women’s choices are respected and supported (except in the case of clinical necessity). Here we encounter not only
two distinct discourses on childbirth but also on the meaning of “progress”.
For obstetricians, progress is symbolised by the availability and logical application of medical technology. For many midwives, however, progress implies
respecting women’s choices while also promoting physiological birth as a desirable goal, with access to technical medical support for those women who desire
or need it. Women who give birth in hospital will often be confronted with
these two different philosophies of birth.
The tensions between obstetricians and midwives become immediately evident if we consider the names assigned to the professionals who assist women
during birth. Even if some of them identify themselves as midwives (parteiras),
they are not officially called midwives, but specialist nurses, thereby emphasising their subordinate role to doctors in the medical hierarchy. In fact, the role
and responsibility of these individuals is not equivalent to that of midwives
within other national health systems such as in the UK or the Netherlands, for
instance. Little effort is made to enhance dialogue between these two groups
through common meetings or clear rules about their cooperation. Midwives
generally consider their work not only as complimentary to that of doctors,
but equally essential. While doctors may also support this vision, the real tensions associated with the daily parallel work of the two professional groups in
the hospital setting is elucidated in this paper. The authors, further, highlight
the difficulties of conducting fieldwork in hospitals. Some doctors’ reluctance
to participate in social scientific studies poses a particular obstacle. Yet doctors’ voices and perspectives are critical to ongoing debates concerning the
future of childbirth in Portugal.
Elizabeth Challinor’s auto-ethnographic article analyses the hospitalised
birth of her third child in northern Portugal, after giving birth at home twice
in the UK. The author provides a first-hand account of a woman’s struggle to
be able to have the birth she wants despite external pressures. Her post-event
reflection on and locating of her personal experiences within the wider Portuguese social and cultural landscape of birthing is not only informative, but
constitutes a meaningful reflection on the liberating and empowering effects
of narrative creation as an act of agency at times when we feel we have little
power.
One of the issues emerging from Challinor’s account is the important role
played by certain health professionals – both midwives and doctors –, “guardian angels,” who try and support women’s autonomy in birthing, and enable
women in their care to subvert the dominant system. As White and Queirós
suggest in their article in this issue, there exist “windows of care” through
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which women giving birth can receive quite varied forms of attention; in some
cases, dedicated, respectful approaches can offer escape from the routinized
medicalisation of birth in Portuguese hospitals.
In the final article of this dossier, Anna Fedele analyses what happens when
women who embrace holistic mothering and choose to give birth at home
end up in a hospital. Fedele reveals the influence that Robbie Davis-Floyd’s
analysis on birth as an American rite of passage in the US (Davis-Floyd 2003
[1992]) has on holistic mothers as well as on international movements for the
humanisation of birth, and the problems related to a dichotomised conceptualisation of an alternative, “wholistic” model and a “technocratic” model
predominating in contemporary hospitals. Fedele argues that the oppositional
construction of these two models can lead to traumatic experiences for those
mothers who choose homebirth but end up giving birth in a hospital. She
argues that more research on issues of gender and power within the movement for the humanisation of birth is needed, not only in Portugal but also
elsewhere. Fedele suggests that this kind of research should include long-term
studies using qualitative analysis, participant observation and the elaboration
of life histories in order to grasp the complex reality of birth and birthing
traumas, in a way that takes into account also their religious and spiritual
dimension.
Homebirth exists in a legal void in contemporary Portugal and is resisted by
many health professionals who consider it a retrograde step. At least up to the
1960s, in Lisbon only a minority of births took place in hospital, and in the
rural areas of Portugal homebirth still represented the most common scenario
throughout the 1970s and into the 1980s, supported by the national health
system. However, women who choose homebirth nowadays tend to be considered as irresponsible and gullible individuals who put themselves and their
babies at risk. Their choices, further, are interpreted as posing a risk to the
entire society, threatening the Portugal modernisation project (see also Fedele
and Pasche Guignard 2018). In this scenario, homebirth is related to a distant,
rural, even primitive past, as opposed to the kind of modern, progressive, European country which “the Portuguese” are understood to be striving for. Indeed,
within this discourse, not only homebirth but other forms of birthing that are
not conceived within the biomedical perspective of intervention to facilitate
birth, such as those which seek to avoid anaesthesia, are similarly considered
to be practices belonging to a rural and pre-modern Portugal (see also White
and Queirós, this volume). Unlike in other European countries such as the
Netherlands, Sweden or the UK, where women opting for homebirth are supported by the state as part of an ongoing collaboration between the midwives
attending homebirth and hospitals, Portuguese women who choose homebirth
are confronted with a lack of support for their choice and poor communication
between the medical establishment and the exponents of the alternative care
BIRTHING MATTERS IN PORTUGAL: INTRODUCTION
615
sector. It is this lack of institutional support and associated poor coordination
which pervades homebirth with particular risk in the Portuguese setting.
The new research presented in this collection highlights the unique potential of ethnography and broader anthropological approaches in analysing and
elaborating the complex cultural dynamics underpinning one of the most
universal human events: that of giving birth. It is our hope that this collection demonstrates how a multi-layered anthropological approach can enhance
understanding of childbirth not only in the Portuguese context but also internationally.
One of Brigitte Jordan’s many contributions to the nascent anthropology
of birth was to distinguish between the debate on what is deemed to be the
“right” approach, and the scholarly analysis of what “counts” in a socio-cultural sense. This distinction emphasises the importance of analysing and
understanding how participants in birth share different forms of knowledge
with each other, ratify it, elaborate it, or in some cases, enforce it (Jordan
1989). In a worldwide scenario in which women in poor countries have no
access to medical assistance should they require it, the demands of women in
Western countries for a more humanized birth can, perhaps, be dismissed by
some as the claims of privileged women who are not aware of the advantages
they hold. This is particularly true in countries such as Portugal, where great
efforts were made following the Salazar dictatorship to establish an effective
public health system and hospital network. While we may have our own personal opinions and positions, however, our energies are firmly devoted to the
academic exposition of socio-cultural dynamics, as reflected in this collection
of papers. It is important to recall that Jordan advocated a seeking of commonality – a dialogic approach of mutual accommodation, proven to be successful
in some settings (Jordan 1992). We are adherents to this approach. Ongoing
dialogue and exchange between academics and the medical establishment, as
well as with representatives of the public health care sector, are essential. Some
strides have already been made by medical anthropology scholars in Portugal
in this area (see, for instance, Pussetti and Brazzabeni 2011), and we support
any new measures which pave the way for more fruitful future collaboration
(though see White and Queirós in this issue regarding the continuing barriers
to conducting social science research in hospital settings).
Joining the efforts of other social scientists to describe the complex identity and power struggles that inevitably surround an event that marks the
entry of a new individual into society, the articles presented in this collection
problematize dichotomies such as hospitalised birth/home birth, technocratic/
wholistic, passive/active birth. On an international level, this ethnographic
work aims to contribute to ongoing efforts to offer new analyses of birth which
go beyond generalising descriptions of the oppositional discourses of specific
social actors (e. g. doctors, midwives, homebirthers), and instead analyse the
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various reflections, collaborations, contestations and contradictions which
emerge in particular situations and settings. In our opinion, comprehensive
analysis and understanding of birth is only possible through the inclusion of
probing primary qualitative studies, including ethnography, as well as birth
narratives, all of which attempt to capture the lived complexities of this deeply
physical, emotional, personal and yet most socio-cultural event.
In the Portuguese context, this collection forms part of a growing and more
visible body of university research activity; further new ethnographic work
is underway at the Institute of Social Sciences (ICS-UL) in Lisbon examining
the cultural understanding of pain in childbirth and of obstetric violence in
Portugal, for example, while wider social science investigation at CIES-IUL is
exploring the choice and meaning of homebirth, a practice which remains controversial in Portugal, despite being supported by the medical system in some
European countries, and even promoted as a safer option for certain groups
of women in the United Kingdom.6 We have also observed a striking level of
interest in the study of birthing practices, experiences and outcomes among
new post-graduate students. Clearly, childbirth is a subject which will not and
should not go away, and we hope that this collection of papers will contribute
to the promotion of this subject in Portugal as a matter of both scholarly and
social importance.
REFERENCES
AKRICH, Madeleine, and Bernike PASVEER, 2004, “Embodiment and disembodiment in
childbirth narratives”, Body and Society, 10 (2-3): 63-84.
AKRICH, Madeleine, et al., 2014, “Practising childbirth activism: a politics of evidence”,
BioSocieties, 9 (2): 129-152.
APDMGP – ASSOCIAÇÃO PORTUGUESA PELOS DIREITOS DA MULHER NA GRAVIDEZ E NO
PARTO, 2015, Experiências de Parto em Portugal: Inquérito às Mulheres sobre as Suas Experiên-
cias de Parto. Lisbon, APDMGP.
AYRES-DE-CAMPOS, Diogo, et al., 2015, “Lowered national cesarean section rates after a
concerted action”, Acta Obstetricia et Gynecologica Scandinavica, 94 (4): 391-398.
DAVIS-FLOYD, Robbie E., 2003 [1992], Birth as an American Rite of Passage. Berkeley and Los
Angeles, University of California Press (2nd edition).
DAVIS-FLOYD, Robbie E., and Carolyn F. SARGENT, 1997, Childbirth and Authoritative
6
See the Birthplace project: < https://www.npeu.ox.ac.uk/birthplace/results > (last access in October
2018).
BIRTHING MATTERS IN PORTUGAL: INTRODUCTION
617
Knowledge: Cross-Cultural Perspectives. Berkeley, University of California Press.
EPP – EURO-PERISTAT PROJECT, with SCPE and Eurocat, 2013, European Perinatal Health
Report: The Health and Care of Pregnant Women and Babies in Europe in 2010, available at
< http://www.europeristat.com/images/European%20Perinatal%20Health%20Report_2
010.pdf > (last access in October 2018).
FEDELE, Anna, 2016, “ ‘Holistic mothers’ or ‘bad mothers’? Challenging biomedical models
of the body in Portugal”, Religion and Gender, 6 (1): 95-111.
FEDELE, Anna, and Florence PASCHE GUIGNARD, 2018, “Pushing from the margins: comparative perspectives on ‘natural childbirth’ in contemporary holistic spiritualities and
natural parenting in France and Portugal”, in M. de la Porte and M. Martin (eds.), Sacred
Inception: Reclaiming the Spirituality of Birth in the Modern World. New York, Demeter Press,
131-150.
JOAQUIM, Teresa, 1983, Dar à Luz: Ensaio sobre as Práticas e Crenças da Gravidez, Parto e Pós-Parto em Portugal. Lisbon, Dom Quixote.
JOAQUIM, Teresa, 2006, Cuidar dos Outros, Cuidar de Si: Questões em Torno da Maternidade.
Lisbon, Livros Horizonte.
JORDAN, Brigitte, 1989, “The ultimate failure: court-ordered Cesarean section: a case of
differing realities”, in L. Whiteford and M. Poland (eds.), New Approaches to Human
Reproduction. Boulder, CO, Westview Press, 13-24.
JORDAN, Brigitte, 1992, “Authoritative knowledge and its construction: introductory
remarks to symposium on ‘Birth in twelve cultures: papers in honor of Brigitte Jordan’ ”,
presented at the Annual Meeting of the American Anthropological Association, Xerox
Palo Alto Research Center and Institute for Research on Learning, San Francisco, CA,
December.
JORDAN, Brigitte, 1993 [1978], Birth in Four Cultures: A Crosscultural Investigation of Childbirth in Yucatan, Holland, Sweden, and the United States. Prospect Heights, IL, Waveland
Press.
KETLER, Suzanne K., 2000, “Preparing for motherhood: authoritative knowledge and the
undercurrents of shared experience in two childbirth education courses in Cagliari,
Italy”, Medical Anthropology Quarterly, 14 (2): 138-158.
KORNELSEN, Jude, 2005, “Essences and imperatives: An investigation of technology in
childbirth”, Social Science & Medicine, 61 (7): 1495-1504.
MARTIN, Karin A., 2003, “Giving birth like a girl”, Gender & Society, 17 (1): 54-72.
MATSUO, Koji, et al., 2009, “Use of uterine fundal pressure maneuver at vaginal delivery
and risk of severe perineal laceration”, Archives of Gynecology and Obstetrics, 280 (5): 781-786.
McCOURT, Christine, 2009 (ed.), Childbirth, Midwifery and Concepts of Time. Oxford, Berghahn Books.
MEAD, Margaret, 1930, Growing Up in New Guinea. New York, Blue Ribbon.
OAKLEY, Anne, 2016, “The sociology of childbirth: an autobiographical journey through
four decades of research”, Sociology of Health and Illness, 38 (5): 689-705.
OE/APEO – ORDEM DOS ENFERMEIROS/ASSOCIAÇÃO PORTUGUESA DOS ENFERMEIROS
OBSTETRAS, 2012, Pelo Direito ao Parto Normal: Uma Visão Partilhada. Lisbon, OE/APEO,
available at < https://www.ordemenfermeiros.pt/arquivo/publicacoes/Documents/Livro_
Parto_Normal.pdf > (last access in October 2018).
PINA-CABRAL, João de, 1986, Sons of Adam, Daughters of Eve: The Peasant Worldview of the Alto
618
ANNA FEDELE AND JOANNA WHITE
etnográfica
outubro de 2018
22 (3): 607-618
Minho. Oxford, Clarendon Press.
PUSSETTI, Chiara, and Micol BRAZZABENI (eds.), 2011, dossier “Vivenciar o sofrimento
social: suas ambiguidades e articulações”, Etnográfica, 15 (3), 467-478.
RAMALHO, Anabela, 2011, Trabalho de Parto no Hospital: A Experiência de Sentir-se Respeitada.
Coimbra, Formasau.
RCM – THE ROYAL COLLEGE OF MIDWIVES, 2012, Evidence Based Guidelines for Midwife-
ry-Led Care in Labour: Rupturing Membranes. London, RCM.
RIBEIRO, Margarida, 1990, Temas de Etnologia: Maternidade. Lisbon, Livros Horizonte.
SANTOS, Mário João Duarte da Silva, 2012, Nascer em Casa: A Desinstitucionalização Reflexiva
do Parto no Contexto Português. Lisbon, ISCTE-IUL, MA thesis in Health, Medicine and
Society.
TANASSI, Lucia M., 2004, “Compliance as strategy: the importance of personalised relations in obstetric practice”, Social Science & Medicine, 59: 2053-2069.
WHITE, Joanna, 2016, “‘But isn’t it the baby who decides when it will be born?’: temporality and women’s embodied experiences of giving birth”, Cambridge Journal of Anthropology, 34: 72-86.
WHITE, Joanna, and Maria Johanna SCHOUTEN, 2014, “Normal birth as a cultural phenomenon”, in Joanna White and Maria Johanna Schouten (eds.), Normal Birth: Experiences from Portugal and Beyond/O Parto Normal: Experiências de Portugal e Além-Fronteiras.
Braga, CICS, and Lisbon, CRIA, 13-20.
WHO – WORLD HEALTH ORGANIZATION, 2010, WHO Evaluation of the National Health
Plan of Portugal (2004-2010). Copenhagen, World Health Organization Regional Office
for Europe.
WHO – WORLD HEALTH ORGANIZATION, 2015, WHO Statement on Caesarean Section Rates.
Geneva, World Health Organization Department of Reproductive Health and Research.