Translated by Marcela Miller
Abstract: This article discusses the creative process of the play The Birth Machine, one of the seven plays for The Birth Project, Royal Exchange Theatre, Manchester, UK. Through depicting five generations of chilbirth in my family, I use dramaturgy and performance to represent the woman’s body as a birth machine disputed by different social segments: as either an object of sacred ritual or a medical commodity.
Keywords: childbirth, dramaturgy, performance, female body
When invited by the Royal Exchange Theatre to write a play about childbirth in Brazil, I had an inspiration. I saw my mother in a chair telling me about my own birth. Before she finishes, she becomes my grandmother telling the story of my mother’s birth. But, again, before she finishes, she becomes my great-grandmother telling the story about my grandmother’s birth . . . I perceived this was an enigma and a sign of what should drive my creative process. But this inspiration still left me with another surprise when I widened my research: I realised myself as a figure in the statistics. My mother, my son, my sister, my brother and I were all numbers telling the story about childbirth in Brazil.
What Do the Numbers Say?
Brazil was chosen to participate in the Childbirth Debate for being the world leader in C-section births. Whilst the World Health Organization recommends that only up to 15% of births may be surgical, in Brazil this number reaches 55,6% of all births.
Trying to understand what these numbers reveal, I encountered the issue of social inequality. Comparing these numbers within the public health system and within the private sector, I found the starting point for the dramaturgy: Are we equal at birth?
I used two parallel lines of research: one regarding the official numbers, collecting data and interviewing specialists; the other was my private research, centred on conversations with people from my own family. I had the genealogic tree of my father side done, because I already had their names, dates and places of birth.
The process of structuring the dramaturgy, following my first intuition, had my own body bear the scar from the birth, by C-section, of my own son as ground zero. He was born within the Brazilian public health system. My body carries the emotional memory of the statistical identity.
But it took me only one step up in the family ladder to discover another question that broadens the understanding of childbirth history in Brazil. Although my own birth was a natural one, also within the public health system, my mother was born at home, with a midwife assisting her mother during her birth. During our talk, we start to discuss an important question: How and why did childbirth become a medical issue?
Returning to statistics, I found that my grandmother from my mother’s side, just as the great majority of women in the 1940s, gave birth to her children at home, assisted by a midwife. Meanwhile, the majority of women of my mother’s generation gave birth at hospitals in the 1970s.
Between the 1940s, when my mother was born, and the 1970s, when I was born, something changed deeply. My mother and my grandmother lived their whole lives in the same neighbourhood. They belonged to the same social class; both were housewives with basic schooling, protected by the public health system. However, despite no significant change in their family income, they had completely different experiences in giving birth: from the midwife to doctor, from home to hospital. Thus, the change must indicate a change in the State policy regarding childbirth.
Childbirth had changed hands: from the family and the community to the hands of the State. It left the realm of traditional knowledge, surrounded by rituals and the use of natural—often herbal—medicines, and entered the realm of formal Medicine, technology and the pharmaceutical industry. This was an expensive change, which was understood by people as a great evolution, and, indeed, a gift from the State to families according to my own mother’s words.
The fact that the women in my family, including myself, gave body (literally) and identity to the numbers provided me with more grounds and encouraged me to write this family documentary based on the telling of true stories interwoven with other stories and some poetical reflections regarding childbirth. I intended this polyphonic linguistic organism, marked by its different syntaxes (because a language transforms itself within the time flow), to reveal a historical, social and political panorama of childbirth in Brazil.
The Transubstantiation of Numbers into Poetics, from Personal to Collective Memory
I mapped my family genealogy and imagined probable situations, such as the birth of my grandfather’s father in an Italian colony in the 1900, just after the family arrived in Southern Brazil.
Joining this family fact to historical research about childbirth in Brazil at the beginning of the twentieth century, it feels right to imagine the scene with an archetypical character taking part in it: a native doula, that is, a midwife.
Thus, my great-grandfather’s birth is narrated by the doula and attributed to his mother by her playwright great-great-granddaughter; 115 years after it occurred in Rio Grande do Sul. This character, however, will not be a stranger from the future, but a woman of her time, an archetypal figure that would be at my ancestors’ side: an old native woman, with knowledge of herbal medicines and the woman’s body, traditionally learnt through orally transmitted myths.
The woman with a child
Needs herbs, herbs to bathe in
And herbs for tea
Swamp smartweed for the kidneys
Pitanga to soothe the bladder
Chicken brooth to make her strong
And nettle leaves for the blood, I tell ye
For when the belly shows
Until it is no more
This is what you must know:
Wetting both hands
Heat it by the fire’s amber Polish the belly as if with sand
If you do it well
As the child grows
Its feet will move up
As the head unfurls
This poem gave me a meter, a scene with its own rhythm, capable of becoming a chant throughout a night of chilbirth, with the hours passing by suggested by the repetition of the chorus. A chant that teaches what to do and what to avoid when following the cycle of the body that will deliver a newborn after long hours of labour.
However, when writing this voice, I felt a need to justify its appearance by defining beforehand the rules of the game. So, I introduced myself as an auto-documentary poet talking about myself and my relatives:
Within my family’s delicate history runs my motherland’s colossal past and present and today I will tell you, inspired by my own relatives, how the childbirth mechanism works in my country.
In order to continue down this chronological journey in the history of childbirth and the evolution of its vocabulary, the next scene presented my father’s birth, only 22 years later, almost exactly to the day, based on the documents used in the genealogic research.
But what had happened in Brazil within those short 22 years? The massive catechesis of the indigenous peoples—and the ongoing genocide spanning over four centuries—was reaching its apex, though religious syncretism, which, by tacit agreement, allowed the survival of their rituals provided they were embedded in Catholic myths. Therefore, the midwife that most likely assisted my great-grandmother at my grandfather’s birth used rituals just as much as midwives in the past, but now invoked the names of saints and used rosary beads and holy water, combined with the same herbal medicines and deep knowledge of childbirth as in the past.
Documentary about the ancient midwives in the North of Brazil
This voice contains both the Catholic syntax of the hymns and typical rural prose, with its peculiar grammar and its pride in kindness and service, despite and above poverty and sacrifice:
Things that happen in a clay house, yeah? So I asked, I told them to warm up some water that I was going to help! And I’ve been doing it since I was a little girl. I must have deliver’d over 1088 children by now. My Saint Antonio and myself!
Fifty years are spanned in three scenes, and we reach the period in which my grandmothers gave birth to my parents. At this moment, I switched from my father’s lineage to my mother’s. I had tried to locate information about my mother’s ancestors and family tree to enable a parallel journey through history but could not find sufficient information in time for the play—there was a schedule to be met.
When I reached my mother’s birth, an aesthetic rupture occurred—and that is the core of this article.
From this point onwards, I was dealing with living persons, in flesh and blood, not with birth certificates and other documents. It was no longer about what my ancestors could have undergone, but, in fact, dealing with living memories of close relatives.
My ancestors giving birth in their own homes, in the company of their families and midwives, by the light of candles lit for the saints and with vows in exchange for a safe delivery required a very specific aesthetic: something lyrical, ritual, poetic, full of chants capable of carrying ages of traditional knowledge. It was almost like the reality of a griot.
From that point on, my close relatives gave birth in hospitals under a doctor’s supervision, with the eventual use of pharmaceuticals and new technological procedures. This new reality directed me towards a more contemporary language, almost verbatim, with less use of aesthetic effects. And it also demanded I become a documentarist in such an incisive way that I suddenly found myself transcribing the talk with my mother into the play.
I chose to impose a radical aesthetic rupture, almost as radical as the rift that separates “family” childbirth from “medical” childbirth. Reality imposes itself over fiction and I relinquished poetry in favour of a documental view.
Daughter: Where were you born? At a hospital or at home?
Mother: What do you mean? At home, of course.
Daughter: How incredible! What about me? Was I born at home?
Mother: No, I was born at home. But when you were born we had more means, so you were born in a hospital. In my time, we were born at home.
Daughter: But why wasn’t I born at home then?
Mother: Because at home the risk of infection was higher. So was the death rate.
Daughter: Right. But, I mean, it was because of poor sanitation, right? Not because of the house itself.
Mother: And how would you know that? Were you there?
Daughter: No, but I read about it.
Mother: Then you know that with home births, more would die.
Daughter: Didn’t my sister die in the hospital though?
Mother: When it’s time to die, one dies anywhere, honey.
Now, it was my turn to recount my son’s birth. I chose to place myself as both author and mother in front of the audience, and tell them directly how it was to give birth to my only son. How disturbed I felt when I realized that I had surrendered to my doctor’s—a woman—arguments and renounced the natural birth I had so desired. The guilt I felt for not having felt the dilation; the anger for not being with my son during his first night on Earth because we were sent to different wards. It was all there—even the intoxicating fascination of looking at my baby for the first time. All these mixed emotions took hold of my body again, with no fourth wall and with no linguistic recourse. Even today, I blush when I think of reliving such an intimate moment in front of an audience without fiction to protect me.
I felt so insecure! She told me the baby was too large for natural childbirth. I wanted my son to come in his own time, but the idea of delivering him with a doctor I had never seen in my life was deeply unsettling.
The reality floored me! After having made the decision, I was compelled to take this to the end. The scene that followed the mandatory C-section delivery, even with no medical necessity, should be the scene that reveals the situation in which natural childbirth in a public hospital is the only way, even when C-section is required.
This type of natural delivery happened to my sister. We seldom talked about it in private conversations, and now it was about to be made public. My sister agreed to my request, but, as I had to get the details about the facts and she lives in another city, it took a more straight-to-the-facts documentary aesthetic:
[17:53, 18/3/2016] ME: Hi, cupcake!
[17:53, 18/3/2016] MARISE: Hi, Ma! Are u ok??
[11:53, 18/3/2016] ME: Listen . . . Can u tell me about Mariana’s birth again?
[11:54, 18/3/2016] MARISE: NO . . .
[11:54, 18/3/2016] ME: Why?! I have to put it in the play!
[11:55, 18/3/2016] MARISE: Baby, do u know what time it is?
One can think that Whatsapp and other written internet interactions are a dangerous form of communication, since they can disguise long-considered affections with their immediate answers, involving no physical presence, allowing no looking into the eyes or comforting voice tone. But it was through Whatsapp that my sister told me her story again, the story of her second daughter’s birth, in which she was more of a victim than a patient at the hands of a doctor who was in a hurry to enjoy his Carnival holidays.
He performed an episiotomy in the wrong direction injuring her vagina and causing great pain that prevented her from walking for two months.
After representing my sister’s injured body via the bodiless and disturbing means of communication of Whatsapp, the play demanded contrast. It was time to tell the story of a friend that took place in the Brazilian mid-west. Maria, pregnant for the first time, was very conscious of the violent delivery my sister suffered in hospital and thus chose another path. I sent her an e-mail asking her to tell me about her struggle to give birth at home. And she did it through a recorded audio.
Why would I do that to my child?!
(To her son) Mike, get the lunch, please!
The hospital was so automated and cold that it looked like a factory.
(To her son) Look! Pay attention, Mike!
What were they trying to suggest? That I had my baby in an assembly line?!
(To the cat) Get down, Tico!
There was no doubt that my documentary had gained life and that I was no longer in control. All I could do was to write the stage directions indicating that this scene would be an audio with an offstage voice.
The Playwright Machine
Everything seemed to make sense. We were no longer within family boundaries. I was now dealing with the story of a friend living in the hinterland. Hers was indeed a far-off voice, although very present. I could not keep myself from bringing her story into the play exactly as it happened. I already had an aesthetic set of documentary scenes, beginning with an interview with my mother over the telephone, then moving to my own voice in direct speech, followed by my sister’s story on Whatsapp, ending with my friend’s story recorded in an audio file. These different treatments for each scene constructed the play but also revealed how a play like this is written. All this was in accordance with my intent to disclose a mechanism—that of childbirth. What I had was a Childbirth Machine conveyed through a Playwright Machine.
Reading in Manchester/ UK, Birth Debate
But there was one last family memory yet to be told—the birth of a nephew, which took place in a luxurious private hospital in São Paulo, the richest city in Brazil, with all forms of medical and technological care, suffused by the aura of a pleasant event for the relatives and special guests. Once more, I was revisiting a memory of mine having adopted a new, radically different perspective. It was no longer the birth of my brother’s son, but the story of a child delivered as a luxury article, reduced to consumer goods.
At this point, I had no poem to save me from the loss represented by this coming to consciousness. I only wanted to keep the love surrounding this memory, but now I could see that my nephew did not need all that to be born. I was conscious of the social inequality within my own family: while my sister experienced a violent delivery, my brother’s wife gave birth surrounded by luxury and excesses of medical care. My first response was a scene steeped in dark humour in which the buying power was reduced to complete frivolous mediocrity and indifference to the humanity of such a moment:
Make your child’s birth into an unforgettable moment! The CineBirth! We transmit it in real time, using latest generation video equipment through a 25-inch plasma screen TV installed in a comfy air-conditioned room with armchairs for up to 12 people. You will be able to watch your child’s birth on YouTube as many times as you wish!
As soon as I wrote that scene, I was in an ethical dilemma for being judgemental, not so much towards capitalism, but toward my brother’s own choice. Now, I had nothing to support me—not a phone call, not Whatsapp, not a simple recording. I had simply my memory, and a memory in which I was not the protagonist. It was not about my choices. I had a description of the event and was unable to put my judgement aside. At this moment, I understood the value of fiction. But I chose to abandon the dark humour and go back to a direct, pure and simple report.
The Money Machine
The play I was writing, my family documentary, became my Frankenstein. I could not look at it anymore. It bore my indignation over childbirth’s relegation to hospitals. Although this system is supposed to represent great progress in the history of our species, in Brazil, at least, it has been transformed into a cruel money-making machine, favouring the pharmaceutical industry, the health insurance market, the doctors’ agenda and the payrolls of public and private health sevices alike; and all to the detriment of women and their babies.
The childbirth machine was neither kind nor beneficial. My own body and my family bore witness to the fact that my sister and I, within the public health system, and my sister-in-law, within the private sector, had all been victims of this machine. We were redeemed only by my friend who refused to cede to pressure and was capable of chosing what was best for her and her baby. However, we should keep in mind that childbirth occurring at home does not necessarily make it the ideal birth.
We, Brazilian women, are in the midst of a tug-of-war: on the one side, the obstetric violence of the public health system; on the other side, the expensive C-section as the perceived solution against this violence.
And all this in a play for the theatre, juggling aesthetic resources that fall hard on the floor of perplexity.
I finished the play reflecting on that very perplexity. An author, a poet on her own, appears in a monologue appealing to the scientific community for research on the eradication of microcephaly. After pushing the autodocumentary to its limits, I still have the reponsibility of empathy and solidarity.
Men and women of science,
We need you
Says mother Earth
While the babies cry
Every discovery is a sign
A sign of compassion
You can hear the silent voice
Of the great force that still wants us alive.
All excerpts from the dramatic text used in this article were translated by Matheus Ciucci
 Liana Carvalho Riscado, “Os sentidos da cesariana entre usuárias do setor privado e público: convivências de estratégias biopolíticas no fazer nascer” [“The significance of the C-section among women users of the private and the public sector: different strategies in the biopolitics of birth process”]. Doctoral Thesis. National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), 2016.
*Marcia Zanelatto is a Brazilian playwright. She has received the Favelas Award and theTranslation of Brazilian Theatre Award, for They Ain’t Got No; 2014 Theatre Producers Association of Rio de Janeiro Award, Best Author, for Frampness; 2009 Brazil Scene Selection Award, for Time of Solitude; 2017 Botequim Cultural Award, Best Author, forThe Body’s Night. She has participated in international events as author: Red Like Embers, London, 2014; Birth Festival, 2016, Manchester; Pen World Voices International Play Festival, New York, 2016; Female Voices from Brazil, Segal Center Theatre, New York, 2017.