Bastos, Maria Helena, PhD student

By Katherine Harrison on 11 May | 0 comments

Biographical notes
Trained as a gynaecologist and obstetrician, and having practiced for almost twenty years in Brazil, I am a visiting research associate at King’s College London and a visiting lecturer for the MSc course module: Safer Motherhood: policy and practice at the Centre for International Health and Development at University College London. I continue to have strong links with Brazil, both through research and teaching, leading an ongoing collaborative project with the University of São Paulo (USP) for the development and testing of interventions to improve women’s health. I am a Cochrane Reviewer, currently conducting a systematic review on the effects of psychological debriefing on postnatal women’s mental health following traumatic childbirth. I am a peer reviewer for ‘Midwifery: An International Journal’, Elsevier Science. My research interest with the GEXcel fellowship in the University of Linköping is to explore gendered violence in the context of maternity care in Brazil.

Peer Review Publications:
• Leap N, Sandall J, Grant J, BASTOS MH, Armstrong A. Using video in the development and field-testing of a learning package for maternity staff: Supporting women for normal childbirth. International Journal of Multiple Research Approaches, 2009. Nov; Vol 3; Issue 3
• Bick D, BASTOS MH, Diniz SG. Unlocking the potential of effective care for life-long maternal and infant health: the need to address the 'invisible' service after birth. Revista da Escola de Enfermagem USP, 2008; 42(3):416-21. English, Portuguese, Spanish.
• BASTOS MH, Bick D, Rowan CJ, Small R, McKenzie-McHarg K. Debriefing for the prevention of psychological trauma in women following childbirth (Protocol). Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD007194. DOI: 10.1002/14651858.CD007194.
• Diniz SG, Bick D, BASTOS MH, Riesco ML. Empowering women in Brazil. The Lancet, 2007; 370 (9599): 1596-98
• Rowan C, Bick D, BASTOS MH. Postnatal debriefing interventions to prevent maternal mental health problems after birth: exploring the gap between the evidence and UK policy and practice. Worldviews Evidence Based Nursing. 2007; 4(2):97-105. Review.
• BASTOS MH, Diniz SG, Riesco ML, Oliveira SJ. Promoting evidence-based maternity care in middle-income countries: challenges and opportunities. Midwifery, 2007; 23(2):111-2.
• Pattinson RC, Say L, Makin JD, BASTOS MH. Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity (Review). The Cochrane Database of Systematic Reviews 2005, Issue 4 Art No: CD002961.pub2. DOI: 10.1002/14651858.

GEXcel project, theme 4 & 5
Routine episiotomy in Brazil: exploring relations between normative beliefs and gendered violence

Gender, sexual and reproductive rights and health are pertinent issues that affect all people and are central to their lives and experiences. Gender and sexuality are distinct but mutually reinforcing systems of structuring how social control mechanism and normative beliefs simultaneously reinforces gender and sexuality norms. The Latin culture of machismo (male dominance) and Marianismo (female submission and perception of suffering as virtuous), is an important contributing factor shaping gendered violence in Brazil. They shape and are in turn shaped by the specificities of each individual in close interaction with the social, political, cultural and economic systems of the country.

Sexual and reproductive health and rights are part of the larger social roles defined for people and determine to a large extent what choices they make. Sexual and reproductive health and rights concern fundamental aspects of people’s lives and are beyond the comprehension of purely medical and scientific discourses.
How is the exercise of these rights, or the lack of it, reflected and embodied in practices and behaviour of women giving birth in Brazil?
The proposed project explores the theme, focusing on how routine episiotomy violates women’s reproductive and sexual health and rights, and explores the normative beliefs either in their macro, meso or micro complexities of personal negotiations with sexuality, health, childbirth, motherhood, gender and violence.

GEXcel project, theme 7 & 8
Exploring the context for maternity care in Brazil and gendered violence: the case of routine episiotomy 
 
BACKGROUND
Episiotomy, a surgical incision into the woman’s perineum (an area of skin and muscles between the vaginal opening and the anus) to enlarge the birth outlet at the time of vaginal birth, is a procedure frequently performed in Brazil. Accumulating evidence has shown the iatrogenic harm of routinely performing episiotomy on women’s health outcomes and experiences of childbirth (Hartmann et al, 2005; Carroli and Mignini, 2009). However most obstetric care professionals in Brazil have not revised their clinical practice to translate this knowledge and reduce this clinical practice (Althabe et al, 2002; Diniz and Chacham, 2004). Recent official statistics on maternal health (PNDS, 2006) indicate that approximately 70.3% of women had an episiotomy performed when giving birth vaginally. This is alarming as performing episiotomy excessively has implications for a woman’s health and postnatal recovery.

Gender, sexual health and reproductive rights are pertinent issues that affect all people and are central to their lives and experiences. Gender and sexuality are distinct but mutually reinforcing systems of structuring how social control mechanism and normative beliefs simultaneously reinforces gender and sexuality norms. The Latin culture of Machismo (male dominance) and Marianismo (female submission and perception of suffering as virtuous) is an important contributing factor shaping gendered issues in maternity care. They shape and are in turn shaped by the specificities of each individual in close interaction with the social, political, cultural and economic systems of the country.

METHODOLOGY
The study employs a user-centred approach to understanding the context influencing the performance of episiotomy in three hospitals from the public healthcare system of the city of São Paulo, Brazil. Furthermore, the study aimed at (1) developing and pilot-testing an educational package for maternity staff to reduce the routine performance of episiotomy; (2) assess knowledge, attitudes and behaviour in relation to episiotomy from the perspective of obstetric opinion leaders, maternity staff and postnatal women, and (3) explore individual and organizational barriers and facilitators to changing episiotomy practice.
Based on formative research, a short in-service interactive, inter-professional educational intervention to promote evidence based childbirth care and avoid routine use of episiotomy was developed. Results are reported from a pilot study designed to test the feasibility and acceptability of an interactive educational intervention delivered to sixty-three maternity staff in two of the three hospital sites. Questionnaires to assess knowledge, attitudes and behaviour of maternity staff and postnatal women, were developed and tested for face validity. Fifty-two maternity staff (doctors, nurse-midwives and midwives) and two hundred and seventeen postnatal women completed the questionnaires. The analysis of quantitative data explored congruence between knowledge, attitudes and perceived behaviour. Qualitative methodology using data from analysis of interviews and document review further explored the context in which routine episiotomy is embedded and describes the knowledge, attitudes and behaviour regarding the performance of episiotomy and suturing. The results were analyzed based in thematic analysis. Initial findings from this study suggest that among the factors that may contribute towards the routine performance of episiotomy is that knowledge of the risks and benefits is lacking among maternity care professionals and women. This research provides new insights to inform the development of effective strategies to improve childbirth practices and reduce the performance of episiotomy in public healthcare system of the city of São Paulo, Brazil.

ANALYTICAL FRAMEWORK
The proposed project for the GEXcel fellowship further explores the theme, focusing on how routine episiotomy violates women’s reproductive and sexual health and rights in the context of maternity care in Brazil.

Drawing from the findings informing my PhD research (i.e., the current normative belief is that routine episiotomy facilitates birth and protects women’s genital and sexual health) I will seek to identify factors associated with the practice of routine episiotomy from a gendered violence perspective. Preliminary analysis explored data for congruence between knowledge, attitudes, behaviour and professed practice. Findings were presented in the context of inter-professional, institutional and popular culture and suggest that knowledge of risks and benefits of episiotomy is lacking among maternity care providers and women. Using a critical discourse analysis based on feminist theories, I will explore how medical discourses shape beliefs, attitudes and behaviours of key stakeholders of maternity care (providers and users). I intend to explore the data for the structure of power and control as manifested in language and the relationship with gendered violence.