Traditional midwives (TMs) or traditional birth attendants (TBAs) exist in most societies. Often, TMs are members of the local community and share culture and traditions with others. They also have high social standing and considerable influence on health practices of local people. More importantly, they play a vital role in pregnancy and birth in many societies. Newar women in Nepal, for example, give birth with the assistance of aji, a grandmother in local term, who can be an experienced older relative or a neighbor. For each family, there is a strong relationship between the family and a particular aji, who can be called upon whenever the birth takes place.
Lefeber and Voorhoever suggest that a TM does not just only deliver babies. Rather, she is familiar with the woman and her family. She also shares cultural ideas about the birth and the preparation of the birth with the woman. TM is knowledgeable about the traditional medicines and rituals which are required before, during, and after birth. As such, the work of a TM is adapted to the social and cultural matrix of which she is a part and her beliefs and practices are consistent with the needs of the local community.
The number of TMs has reduced dramatically in many traditional societies although there are still TMs delivering infants, particularly in remote areas where modern health care is not accessible to many poor women. It has been suggested that approximately 90% of poor women and those living in rural areas in India continue to give birth with the help of dais, or local TMs. Indeed, recent studies have pointed to the existence and persistence of traditional midwives in different societies.
In Thailand, a TM is called mor tamyae in some parts but referred to as mae jang in the North, is a caregiver of women in childbirth. Mae jang delivers babies in the villages, and assists women with postpartum practices during the first month after birth. When the labor begins, mae jang will be summoned to the woman’s home. A husband is expected to assist mae jang and the laboring woman. The birth mostly takes place in the kitchen, where hot water can be prepared. Mattresses are folded up for the woman to prop her back up against when pushing. A husband provides physical support to a laboring woman. He sits behind her with his legs astride her shoulders so that when contractions are intense she holds on to his muscled thighs, which give her strength to push. A piece of strong wood or bamboo is tied to a post or a wall where the woman can push her feet against. If there is no husband assisting a woman at birth, a piece of long cloth or rope is hung onto the rafters of the room. This is for the woman to cling onto when contractions are intense. The TM squats at the woman’s thighs and waits to catch the baby when it emerges so that the baby will not drop. After the birth, the husband boils the water which the midwife will use to wash the placenta, clean the body of the new mother and the newborn. He also cleans up the remnants of the birth and the floor, prepares a bed for his wife who must observe a postpartum ritual for the whole month, and buries the placenta of his newborn infant.
Mae jang may also help a woman to have an easy birth by manipulating her abdomen and uterus during pregnancy. This is known as “klang tong” or “kwag tong” in northern Thai. Essentially, the midwife massages and pushes the uterus upward to make it “loosen up.” This will create enough space within the uterus, not only to make the baby move more easily in the womb, and hence, make it easy to emerge, but also to ensure that the baby is not squashed and deformed inside the womb. This ritual is done two to three times per week from the sixth month onward.
The Safe Motherhood Initiative has advocated, in a bid to reduce maternal mortality, for an increase in the number of skilled birth attendants including TMs, so that women in rural areas and resource-poor settings who have limited access to modern maternal health services and care may have safe births. Although attempts have been made in many societies, it seems that there are still many obstacles to achieving this outcome. Births assisted by TMs are still largely seen as unsafe. In societies where discourses of modernity are pervasive, such as in most Western societies, TMs would still be perceived as not only ignorant, but also dangerous and dirty. Thus, the presence of TMs in Western societies would still be unimaginable to many women, and there are lots more to be done to bring back TMs in many societies.
Immigrant women who reside in Western societies where TMs are not recognized face difficulties when they become pregnant and give birth in Western hospitals. They have to rely on the medical model of care and are isolated from familiar faces during a critical time. Most maternity hospitals in Western societies permit a husband to be present at birth. However, in a society where men are not culturally permitted during birth, it can lead to conflicts and emotional turmoil in the women, their husbands, and families. Also, women may wish to have other people such as their mothers, sisters, and particularly TMs who can provide culturally sensitive support during this critical period. Therefore, the lack of acceptance of TMs and their support in Western hospitals can impact on the well-being of many new mothers from immigrant backgrounds.
In many societies, traditional births are replaced by modern and medicalized birth. Although there is no denial that modern birth can be beneficial to many women, overmedicalized birth has made other types of birth, such as births assisted by TMs, irrelevant. It has, however, been evidenced that TMs can provide support during pregnancy and birth in clinical settings so that a more “humanized birth” can be achieved. In order to make birth less frightening to many women including immigrant mothers, there is a need for a trusting collaboration between modern obstetric and traditional midwifery care. Ultimately, this will lead to culturally sensitive birthing care to many women in traditional societies in general, and to immigrant mothers in particular.
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