A bird flies over the city of Rio de Janeiro, on June 21.2022. The "cidade maravilhosa" is a city of contrasts: on the one hand, nature of stunning beauty; on the other, a harsh daily life for many of its inhabitants. Ethnic, racial and gender discrimination is ingrained in Brazilian society, and health services participate in these violent practices. Obstetric violence is widespread in the country and for black pregnant women, this problem is aggravated by institutional racism: they are twice as likely to suffer violence during pregnancy and childbirth. In the last two years, the maternal mortality rate has doubled. But there is hope: nurse-midwifery and midwifery organizations, doula programs and activists are fighting for safe and empowered childbirth.
Makeup artist Fernanda Leal breastfeeds her son Jonás at her home in the Alto da Boa Vista neighborhood, Rio de Janeiro, Brasil, on June 23, 2022. She suffered from obstetric violence in both of her births, including that they missed a dangerous condition during her pregnancy: She had vasa previa - both she and her son could have died during pregnancy and birth. Due to institutional racism, a black women has double the risk to die in childbirth than a white woman.
After several hours of labor, Thayline Santos is prepared for a C-section at the Maria Amélia Buarque de Hollanda public hospital in Rio de Janeiro, Brazil, on June 22. 2022. Although the WHO adverts against the risks for baby and mother of unnecessary c-sections, with 55,5% of all deliveries, Brazil has one of the highest rates in the world. Following a more humanized approach of cesareans, Thayline was able to hold her daughter still on the operation table and breastfeed her for the first time in the so-called golden hour after birth.
The placenta rests in a container after a cesarean section at the Maria Amelia Public Maternity Hospital in Rio de Janeiro, on June 22, 2022. The mother received a color print of her placenta after the operation, as a memento of the organ that nourished and provided oxygen to her baby during the months of gestation.
Louise Monier, doula, poses for a portrait at the Doula Association of Rio de Janeiro, in Rio de Janeiro, Brasil, on June 20, 2022. Louise had her first child at the age of 18, a boy with special needs who died at the age of seven. During his birth, she suffered all forms of obstetric violence: verbal, physical and psychological. Many years later, she had another child and this time, she was informed about institutional racism and was accompanied by a doula. Inspired, she became a doula herself, to help other women during childbirth.
In the shower, doula Keylla Moreira holds Maria Cibele Ramos during her last minutes of labor at the Maria Amelia Public Maternity Hospital. At the end of her strength, Maria cries out and Keylla holds her, in a scene full of support and tenderness. Those seconds before the birth of a baby are often called "fugue". It is also the instant when the mother doesn't want to endure any more pain. Experienced midwives and doulas - like Keylla Moreira - know how to guide women through this stage.
Little Isaac greets the world with a loud cry during his birth at Maria Amélia Hospital in Rio de Janeiro, Brasil, on June 22, 2022. His mother, Maria Cibele Ramos, was accompanied during the delivery by her husband and doula Keylla Moreira, who is part of the hospital's doula program.
Gabriella Fernanda de Oliveira, a doula, sits on her bed with her second daughter, who suffers from a genetic disease, in Rio de Janeiro, on June 24, 2022. Her four children, the last twins, were all born by cesarean section. The first was planned and she didn't know she had a choice, the postoperative period was overshadowed by pain and the struggle with breastfeeding. After getting as much information as possible, she decided to be accompanied by a doula for her second birth at the Maria Amelia Maternity Hospital. But due to prolonged labor, she gave up hope and agreed to another cesarean section. With her twins, she was determined to give natural birth, but the doctor wouldn’t allow her and she was forced to have another c-section. After a few days, she noticed the enormous cut they had left her - like a cross.
Thayline Santos breastfeeds her newborn daughter for the first time after a cesarean section at Maria Amélia Hospital in Rio de Janeiro, Brasil, on June 22, 2022. It is said that the first hour after birth is crucial for the bond between mother and baby, and the first milk, called colostrum, is full of essential nutrients and natural vaccines for the newborn.
Midwife and nurse midwife Ariana Santos sits for a portrait at Sankofa's downtown office, in Rio de Janeiro, Brasil, on June 21, 2022. Ariana is part of a team of nurse midwives and obstetricians who especially care for pregnant black women, often from the suburbs, during pre-partum, labor and postpartum, offering a different possible path and a self-determined birth filled with joy and companionship. Ariana became a midwife by accident and was on the verge of ending her career after witnessing constant obstetric violence, sometimes well-intentioned, but other times filled with hate and intentional pain, that she could no longer endure. But one day a friend asked her to accompany her in a home birth and that changed Ariana completely. Years later she learned that her grandmother was a midwife. The profession was in her blood. That is why she calls herself a nurse midwife, because it is the university degree and represents scientific knowledge, but also a midwife, because it represents ancestral knowledge and traditions passed down through the generations. Sankofa means to look back and take the good from the past.