Overcoming the culture of physical immobilization during labor and birth remains a challenge in Brazil. This study identified facilitators and barriers to implementing freedom of movement throughout labor and birth in a pilot project of the Mother-Baby Friendly Birthing Facilities Initiative in a public maternity facility in São Paulo, Brazil using the Change Laboratory methodology. There was a divergence between health managers’ and professionals’ perceptions of maternal care practice and those of the service users and the observations made in the facility. Freedom of movement seemed to be more respected during labor than at birth. Birthing mothers were regularly “positioned” in the lithotomy position, considered by health professionals to be an “instinctive” or “preferred” position. Women reported that they failed to take the initiative to move for fear of being reprimanded by health professionals. Simple changes to the ambience and professional training for health professionals in care provision in nonsupine positions could help foster change.
Public health; Women’s health; Humanization; Childbirth care; Obstetric violence