CHILDBIRTH ACROSS CULTURES

SCIENCE ACROSS CULTURES: THE HISTORY OF NON-WESTERN SCIENCE

VOLUME 5 CHILDBIRTH ACROSS CULTURES

Editor HELAINE SELIN, Hampshire College, Amherst, MA, USA

For further volumes: http://www.springer.com/series/6504

CHILDBIRTH ACROSS CULTURES

Ideas and Practices of Pregnancy, Childbirth and the Postpartum
Editor HELAINE SELIN Hampshire College, Amherst, MA, USA Co-Editor PAMELA K. STONE Hampshire College, Amherst, MA, USA

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Editor Helaine Selin School of Natural Science Hampshire College Amherst MA 01002 USA hselin@hampshire.edu

Co-Editor Pamela Kendall Stone School of Natural Science Hampshire College Amherst MA 01002 USA pksNS@hampshire.edu

ISSN 1568-2145 ISBN 978-90-481-2598-2 e-ISBN 978-90-481-2599-9 DOI 10.1007/978-90-481-2599-9 Springer Dordrecht Heidelberg London New York
Library of Congress Control Number: 2009926833 Springer Science+Business Media B.V. 2009 No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microlming, recording or otherwise, without written permission from the Publisher, with the exception of any material supplied specically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

To my children. And especially to my granddaughter, Enna Rae Selina Sherwin, born 5th August, 2009.

Contents

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction by H. Selin . . . . . . . . . . . . . . . . . . . . . . . . . . . Birth and the Big Bad Wolf: An Evolutionary Perspective . . . . . . . . Robbie Davis-Floyd and Melissa Cheyney Breastfeeding and Child Spacing . . . . . . . . . . . . . . . . . . . . . . Rebecca Sundhagen Culturally Diverse Women Giving Birth: Their Stories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lynn Clark Callister and Inaam Khalaf A History of Western Medicine, Labor, and Birth . . . . . . . . . . . . . Pamela K. Stone Childbirth in China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Travis Anna Harvey and Lila Buckley Childbirth Among Hong Kong Chinese . . . . . . . . . . . . . . . . . . Ip Wan-Yim Childbirth in Korea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sukhee Ahn Childbirth in Japan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Satoko Yanagisawa A Sacramental Theory of Childbirth in India . . . . . . . . . . . . . . . Harish Naraindas Rural Midwives in South India: The Politics of Bodily Knowledge . . . Kalpana Ram Constructions of Birth in Bangladesh . . . . . . . . . . . . . . . . . . . Kaosar Afsana and Sabina Faiz Rashid

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33 41 55 71 77 85 95 107 123

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Pregnancy and Childbirth in Nepal: Womens Role and Decision-Making Power . . . . . . . . . . . . . . . . . . . . . . . . . . . Pratima P. Acharya and Dilu Rimal Pregnancy and Childbirth in Tibet: Knowledge, Perspectives, and Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sienna R. Craig Nyob Nruab Hlis: Thirty Days Connement in Hmong Culture . . . . . Pranee Liamputtong Pregnancy, Childbirth and Traditional Beliefs and Practices in Chiang Mai, Northern Thailand . . . . . . . . . . . . . . . . . . . . . . Pranee Liamputtong Childbirth Experience in the Negev The Southern Region of Israel . . Iris Ohel and Eyal Sheiner Childbirth and Maternal Mortality in Morocco: The Role of Midwives . Marie Hatem, Fatima Temmar, and Bilkis Vissandje Childbirth in Zimbabwe . . . . . . . . . . . . . . . . . . . . . . . . . . . Thubelihle Mathole and Simukai Shamu Childbirth in Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hadiza Shehu Galadanci and Suwaiba Ibrahim Sani Childbirth in Tanzania: Individual, Family, Community . . . . . . . . . David P. Urassa, Andrea B. Pembe, and Bruno F. Sunguya Culture, Pregnancy and Childbirth in Uganda: Surviving the Womens Battle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Grace Bantebya Kyomuhendo Childbirth Experiences in Malawi . . . . . . . . . . . . . . . . . . . . . Lennie Adeline Kamwendo Navajo Birth: A Bridge Between the Past and the Future . . . . . . . . R. Cruz Begay Childbirth in the Mayan Communities . . . . . . . . . . . . . . . . . . . Linda V. Walsh Converting Birth on Simbo, Western Solomon Islands . . . . . . . . . . Christine Dureau Childbirth in Australia: Aboriginal and Torres Strait Islander Women . Sue Kildea and M. Wardaguga Biographies of the Authors . . . . . . . . . . . . . . . . . . . . . . . . . Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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175 185 195 205 215 221

229 235 245 255 265 275 287 297

Contributors

Pratima P. Acharya Auckland City Hospital, Auckland, New Zealand, ppoudel@yahoo.com Kaosar Afsana Health Programme, BRAC, Dhaka, Bangladesh, afsana.k@brac.net Sukhee Ahn School of Nursing, Chungnam National University, Korea, sukheeahn@cnu.ac.kr R. Cruz Begay Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona, USA, Cruz.Begay@nau.edu Lila Buckley Global Environmental Institute, Beijing, Peoples Republic of China, buckleylila@gmail.com Lynn Clark Callister College of Nursing, Brigham Young University, Provo, Utah, USA, lynn_callister@byu.edu Melissa Cheyney Department of Anthropology, Oregon State University, Corvallis, Oregon, USA, cheyneym@onid.orst.edu Sienna R. Craig Dartmouth College, Hanover, New Hampshire, USA, sienna.craig@dartmouth.edu Robbie Davis-Floyd Department of Anthropology, University of Texas, Austin, Texas, USA, davis-oyd@mail.utexas.edu Terry Dunbar Charles Darwin University, Darwin, NT, Australia, terry.dunbar@cdu.edu.au Christine Dureau Department of Anthropology, University of Auckland, Auckland, New Zealand, cm.dureau@auckland.ac.nz Hadiza Shehu Galadanci Senior Consultant Obstetrician and Gynaecologist, Aminu Kano Teaching Hospital, Kano, Nigeria, hgaladanci@yahoo.com Travis Anna Harvey Co-founder and owner, Heliocentric, travis@heliocentric.org Marie Hatem Dpartement de mdecine sociale et prventive, Universit de Montral, Montral, Qubec, Canada, Marie.hatem@umontreal.ca

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Contributors

Ip Wan-Yim Nethersole School of Nursing, Chinese University of Hong Kong, Shatin, NT, China, ip2013@cuhk.edu.hk Lennie Adeline Kamwendo Association of Midwives of Malawi, lennieakamwendo@yahoo.co.uk Inaam Khalaf Faculty of Nursing, Jordan University, Amman, Jordan Sue Kildea School of Nursing and Midwifery, Australian Catholic University, Brisbane, Australia, Sue.Kildea@acu.edu.au Grace Bantebya Kyomuhendo Department of Women and Gender Studies, Makerere University Uganda, Kampala, Uganda, gbantebya@ss.mak.ac.ug Pranee Liamputtong School of Public Health, La Trobe University, Bundoora, Victoria, Australia, pranee@latrobe.edu.au Banyana Cecilia Madi Policy Development and Harmonisation, HIV and AIDS Unit, SADC secretariat, Gaborone, Botswana, banyana@bcmadi.com Thubelihle Mathole School of Public Health, University of the Western Cape, Cape Town, South Africa, tmathole@hotmail.com Harish Naraindas Centre for the Study of Social Systems, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India, harish-naraindas@uiowa.edu Iris Ohel Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Beer-Sheva, Israel, ohel@bgu.ac.il Andrea B. Pembe Department of Obstetrics and Gynecology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, andreapembe@yahoo.co.uk Kalpana Ram Department of Anthropology, Macquarie University, Sydney, Australia, Kalpana.Ram@scmp.mq.edu.au Sabina Faiz Rashid James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh, sabina@bracuniversity.ac.bd Dilu Rimal dilurimal@hotmail.com Suwaiba Ibrahim Sani Helaine Selin Hampshire College, Amherst, Massachusettes, USA, hselin@hampshire.edu Simukai Shamu Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, shamuts@yahoo.com Eyal Sheiner Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, sheiner@bgu.ac.il

Contributors

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Pamela K. Stone School of Natural Science, Hampshire College, Amherst, Massachusetts, USA, pksNS@hampshire.edu Rebecca Sundhagen Nurse Manager, Passport Health Colorado, USA, rsundhagen@yahoo.com Bruno F. Sunguya Muhimbili University College of Health Sciences, Dar es salaam, Tanzania, sunguya@gmail.com Fatima Temmar Inrmire- sage femme et enseignante lInstitut de formation aux carrires de sant, Rabat, Maroc, temmar_fatima@yahoo.fr David P. Urassa School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania, durassa@muhas.ac.tz Bilkis Vissandje School of Nursing, University of Montreal, Montral, Qubec, Canada, bilkis.vissandjee@umontreal.ca Linda V. Walsh University of San Francisco, San Francisco, California, USA, walsh@usfca.edu Molly Wardaguga Retired Senior Aboriginal Health Worker, Founding Member Malabam Health Board, Maningrida, Australia Satoko Yanagisawa Faculty of Nursing, Aichi Prefectural University, Aichi, Japan, sayanagi@nrs.aichi-pu.ac.jp, sarahyana@hotmail.com

Introduction: Babies Can Be Born Anywhere

Helaine Selin

In 1969, I gave birth to my rst baby in Malawi, Central Africa. I had been a Peace Corps Volunteer, and America seemed a scary place at that time, with political and social upheaval. I wanted to stay in Africa, which was then a peaceful and gentle place. My son was born without complication in a small hospital with very minimal intervention. My American doctor had told me to get help if I needed to use the toilet, and I rang for the nurse after a short while. When she arrived, she asked if I were okay, and when I said I was but that I was supposed to get assistance, she said, All you did was have a baby. Perhaps this sounds rude, but it was of course true. So I walked down the hall and took a hot bath (the nurse came along and put some salt in it, to soothe the perineal area). An hour later, my hospital roommates family arrived with a big platter of hot curry, and I sat on her bed and shared it with her. The whole atmosphere was very joyous this was her fourth baby, born after the other children were grown and we were both delighted with our achievements. Two years later, I was in New York State, and when I got pregnant again I went to see the obstetrician that everyone went to. I explained that I had never been in a hospital (the one in Malawi didnt quite count) and that I was anxious about it. He said that I didnt need an obstetrician; I needed a psychiatrist. That set me on the road to nding a better way to have a baby, and I ended up in a Maternity Hospital (that had previously been a Maternity Home), run by women doctors. I had to do a bit of lying during my labor. I didnt want my pubic hair shaved, so I told one nurse that the doctor said I didnt have to, and I had to ght not to have an episiotomy the fact that the baby was small made the doctor agree. This was a very easy birth, and the doctor warned me that I shouldnt say anything about it to the other women in the ward they would be in pain and already annoyed at me because I kept the baby with me and they couldnt smoke in the room. I was able to leave a few hours after my daughter was born. The experience was wonderful, but that was only because I knew how to advocate for myself and because the birth was uncomplicated. I noticed that I wasnt supposed to take a bath for three weeks, while in Malawi I had

H. Selin (B) Hampshire College, Amherst, MA, USA

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one right away. The relaxed attitude was gone; even in my case it was clearly a medical procedure, although nothing like what women go through now in America. A colleague of mine, Rebecca Miller, had her rst baby when she was a Fulbright scholar in Carriacou (Grenada), in the Caribbean. She had been concerned about having a baby overseas, but her mother had reassured her, Babies can be born anywhere. She had her second baby at Yale University Medical Center a hi-tech, ultra-modern environment. And even though her births were much more difcult than mine, the one in Carriacou was full of joy and comfort a human, bonding experience with the staff and the parents and baby. The one in Connecticut took all the joy out and replaced it with technology. In her descriptions of the birth, one of the notable things was color the Caribbean birth seemed to occur in a world of green and owers; the US birth was grey. I started to compile this book with the notion that I would learn the different ways that birth is experienced around the globe. What Ive discovered has been a bit of a shock. Increasingly, around the world, and certainly in urban areas, the medical model of childbirth is winning out and wiping out traditional methods. I see two explanations for this. One is that there is an association between the concept of modern and having babies in a hospital. The old ways are clearly outdated, and the way to show progress is to have a medicalized birth. As Davis-Floyd and Cheney say in their chapter, the inuences of industrialism, technocracy, and gendered power inequities have generated a biomedical hegemony that has been perpetrated around the world through both colonialism and the maladaptive imitation of what appears to be best because it is modern. The other has to do with the culture of fear that is spreading everywhere. We are increasingly afraid of the old ways. Many women choose to have a cesarean birth, because of the fear of childbirth pain. In 2007, the National Center for Health Statistics released the preliminary US national cesarean rate for 2006: 31.1%. This rate has increased by 50% over the past decade, reaching a record level every year in this century. The World Health Organization also shows record increases in cesareans for many countries. As Harvey and Buckley say in their article on China, the scientic method of the cesarean-section delivery becomes the ultimate modern and civilized way of bringing order to the chaotic and unruly process of birth. However, the high cost of cesarean delivery compared to vaginal birth means that only those of means can afford this modern, civilized, technological birth experience. Therefore, cesarean birth has in many circumstances become a status choice, rather than a medical choice. (In some hospitals in China, the rate of cesarean is as high as 90%). There is also the notion that a cesarean is safer than a vaginal birth. This is patently false. First, it is true that pain during labor is lower with a cesarean, but the pain after is much more intense and goes on so much longer. The mother has had major surgery (although this is often downplayed in discussions of the procedure) and will have two to six weeks of recovery in addition to dealing with a newborn baby. Risks to the mother are much higher: inammation and infection of the membrane lining the uterus, increasing bleeding, urinary tract infection, decreased bowel function, blood clots, wound infection, reactions to anesthesia, and increased

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risks for future pregnancies. Risks to the baby include breathing problems and fetal injury from the knife (MayoClinic.com). More and more women seem to follow the obstetricians idea that cesarean birth is more orderly and controlled (Bryant et al. 2007). The irony is that countries around the world that are trying to be modern are having increasing rates of cesarean birth and over medicalized birth experiences, while some in the US are trying to de-medicalize the experience. It is different in Europe because there is national health care, so there is no reason to encourage expensive hospital birth for normal pregnancies. The government actually encourages having babies at home if everything is ne. In my country and elsewhere, childbirth is a big money maker. Yanagisawa, in her chapter on Childbirth in Japan, cites a paper by Shirai who observed, while studying old midwives, that old midwifery followed values of aesthetics and etiquette. These values changed to safety and hygiene. We have given up the ecstasy of childbirth for a sterile, safe, vacant experience. The matter of ecstasy is a real source of concern. In a recent study (2008), paradoxically at Yale University, James Swain and his team discovered that mothers of babies born naturally were more sensitive to hearing their own childs cry than those who had caesarean births. Brain areas related to mood were also more active in mothers who had delivered their children via natural birth. One explanation was that the hormone released during birth, oxytocin, is not released during the cesarean operation. Interestingly, there is also an increase in post-partum depression in mothers who have cesarean births. Many articles in this book express the view that home births are unsafe and that it is the combination of the home birth and the difculty of getting to a hospital in rural parts of the Third World that is responsible for high infant and maternal deaths. When I asked the authors for evidence for this, they werent really able to give it. Many accept the World Bank and World Health Organizations views, which seem to me to be quasi-colonial, that having babies at home is dangerous and somewhat backward. Harish Naraindas addresses this issue in his chapter on India and cites Alpana Sagar, who said that there is no evidence that infant mortality is higher at home. This is not to say that the old ways are denitely better. Some of us are fortunate to be able to have choices and pick which parts of the traditional and modern suit us best. But in much of the world, women still cannot make decisions about their birth experiences. Their husbands or mothers-in-law make decisions for them, which sometimes results in their death or their babies. Many cultures, such as Morocco and Bangladesh, encourage silent and sometimes solitary births. Women must go through the experience without crying out, or they bring disgrace on their families. In many cultures, such as Bangladesh and the indigenous people of Australia, childbirth is womens business, and one of the problems of hospital or clinic births is that male doctors and attendants are present. There is also often a problem with the exposed method of birth practiced in the West; many women in cultures that demand modesty of women, such as the Simbo people in the Solomon Islands, are horried to have their vaginal area open and exposed to anyone, including other women.

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On the other hand, especially in Asian cultures, there is a long period, postpartum, where women are treated especially well, encouraged to do nothing besides feed the baby and relax. In other cultures, the mother in the post-partum period is considered unclean and polluted, as with the Hmong, and she must stay in a separate place for weeks. In editing this book, Ive realized that women have a rough time. Either they have overbearing husbands, mothers-in-law, nurses, or doctors, who dictate how they should behave and what they should eat and drink, or they are left on their own to tackle an often frightening experience. It is true that babies can be born anywhere, but often the experience for the mother is a difcult and dangerous one. Childbirth Across Cultures explores the childbirth process through globally diverse perspectives in order to offer a broader context with which to think about birth. From the prenatal stages to the postpartum, a myriad of rituals, herbal management, and women-centered assistance mark labor and birth as biocultural events. Another situation common to childbirth is the notion of power. Who controls the pregnancy and the birth? Is it the hospital, the doctor, or the in-laws, and in which cultures does the mother have the control? These decisions, regarding place of birth, position, who receives the baby and even how the mother may or may not behave during the actual delivery, are usually made by other people. In the United States, it is often the technology associated with birth, and the people who know how to operate it, that direct the birth process. But in many parts of the world, the mother may have less authority than the midwife or her mother-in-law. The book is divided into two parts. The rst contains three chapters: (1) a fascinating evolutionary perspective on birth, (2) childbirth narratives, and (3) breastfeeding and child spacing. These differ from the other chapters, because they are multicultural and not related to one place, and they pave the way for the others. In another sense they could be put at the end of the book, because they also explain and give meaning to the other chapters. We think it will be good to bear them in mind as you read the others. The next section starts with a history of childbirth in America. This might seem to have no place in this book, but as I just said, the American way of birth is spreading around the world the way blue jeans and Coca-Cola has. The other articles deal with individual countries, although not, of course with individual cultures, as many countries have many different ethnic groups. We can hardly speak of West and East anymore, not to mention trying to talk about a country like India as one homogenous place. The article on Indian midwives is apt in this case, as it deals with rural midwifery as a form of knowledge. What Dr. Ram says applies to many other cultures, even in the West, with regard to midwives. We succeeded in having chapters from every continent, although the absence of Europe might be noted. My advisory editors and my intent originally was to cover the non-Western world, although again those lines are increasingly blurred, and it seemed necessary to include some material on America, although we also included one of the North American indigenous cultures, the Navajo.

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We hope that the research in this volume, conducted by professional anthropologists, midwives and doctors who work closely with the individuals from the cultures they are writing about, will offer a unique perspective direct from the cultural group.

Reference
Bryant, Joanne, et al. Caesarean Birth: Consumption, Safety, Order and Good Mothering. Social Science & Medicine 65 (2007): 11921201.