Global Midwives

Birthing the Future

By Robbie Davis-Floyd

"In the Netherlands, midwives attend over 70% of all births, and one in three children is born at home. The Netherlands has one of the highest percentages of normal childbirths and the lowest percentages of infant and maternal deaths in the world."

As the birth of your first child approaches, the midwife comes daily. For 10 days she massages your taut belly and aching back with herbal oils and sings songs to welcome the child to the world.

She instructs your family on your diet and care, leaving behind fresh fruits, nuts, and teas to nourish your blood. When the time comes, the midwife presides over your own personal labor team of aunties and cousins. Each has her own task: one mixes herbs, one massages your legs with shea butter, another helps you change positions, another talks praises and encouragement in your ear.

When at last your child emerges, he is placed directly on your chest, the cord intact, to allow a gentle transition. For weeks afterwards you stay in bed nursing, sleeping, and bonding with your child. Your family and friends take care of all the household tasks. You are bathed and massaged everyday. Everything is brought to you, your favorite protein-rich foods: fish, shrimp, sweet potatoes, palm oil.

Celebration is in the air; everyone recognizes that you have survived a passage between life and death. Post-partum depression is unknown. If you become unhappy, someone is always there to shake you and say, "Why are you sad? You are blessed with a beautiful baby!" The midwife checks in on you regularly to assuage your fears and questions. She is respected in the village; no one can replace her. She catches life.

Since the dawn of humanity, birth—in its raw, awe-invoking splendor—has traditionally been the domain of the trusted and skilled hands of village midwives. Called "the special ones," the "Grand Midwives," and "spiritual healers," they carefully guarded the sacred threshold from womb to the world.

Societies honoring skilled midwives typically have borne the signature of cultures where women and children—and women's ways of knowing—are highly valued.

Today, however, the march of medical modernization is steadily eroding the status of traditional midwives in many areas of the world. Midwives are increasingly vanishing, and often with them, an empowering and sacred culture of birth for new families.

Yet in some regions, the winds of change are stirring a global midwife renaissance. Contemporary midwives are championing this resurgence by fusing holistic, empowering, traditional practices with beneficial aspects of medical science. Struggling for the freedom to practice without their "hands tied" and to secure respect from governments, institutions, and local communities, they are increasingly networking and organizing politically with a sense of mission to protect the welfare of mothers and babies.

"The winds of change are stirring a global midwifery renaissance."

In the West, perceptions of birth have changed since the rise of the science of obstetrics in the mid-18th century. Childbirth has become a medical event and is subtly regarded as an illness. From the moment a woman's pregnancy is confirmed, health professionals begin to focus on potential problems. Once labor starts, a woman transfers to a hospital, is placed in a wheelchair, and is led to a room full of IV drips and fetal monitors. She frequently gives birth on her back, drugged, under glaring lights, with her feet in stirrups. Forceps, vacuum extractors, epidurals, episiotomies, and unnecessary cesarean sections are often used.

This medical model continues to spread globally, despite the fact that countless studies show that midwives not only typically give women more nurturing care than do most physicians, but that they are also generally more cost-effective and often have better outcomes.

Interestingly enough, it is in the regions where midwifery was all but wiped out, particularly in the U.S. and Canada, where we are witnessing strong revivals. Although U.S. nurse- and direct-entry midwives currently attend only about 10% of births, this rate is increasing at about 1% per year. In Canada, midwifery is presently being legalized in all provinces, and as Canadian midwives gain legal status, the percentage of births they attend is rising.

"As steadfast guardians of life and blenders of the best of science and tradition, midwives hold the promise of a world of health for all in their hands."

In not every case is midwifery beneficial. Not all traditional midwives are skilled, and some indigenous customs can be harmful. There are also increasing reports, primarily in the Global South, indicating that some professionally trained midwives are treating women poorly. These midwives are themselves often treated badly: almost always underpaid, frequently mistreated by physicians, and working long hours under stressful conditions that often include inadequate facilities.

In contrast to these incidents, a phenomenon is emerging globally that I call "postmodern midwifery." Postmodern midwives know the limitations and strengths of the Western medical system and of their own, and they can move fluidly between them.

They are scientifically informed, articulate, organized, political, and highly conscious of both their cultural uniqueness and their global importance. They are mediators, crossing the boundaries between obstetric care and alternative care, home and hospital, modern and traditional, local and international. These midwives are working to ensure that the uniquely woman-centered dimensions of midwifery remain intact. They are shape-shifters and know how to subvert the medical system where appropriate while often complying with it. They make alliances with Western medicine where possible and make connections with other midwives internationally to create a global culture of midwifery as well as to preserve and teach to others the best of their own cultural traditions around birth.

©Nancy Durrell McKenna
Beyond birth, midwives are often providers of total community health care. Their repertoire might include setting bones, massage, practicing prenatal and post-partum care, and administering herbs and nutritional information. They are frequently known as spiritual leaders, community organizers, and public health activists.

Recently, I encountered a flat marble delivery table complete with metal stirrups at a birth center owned by Doña Facunda, a partera tradicional (traditional midwife) in Morelos, Mexico. Doña Facunda, with a mischievous glint in her eye, pointed out that her clients' relatives believe in hospital procedures, including giving birth on the back. "If they want me to act like a little doctor (minimédico)," she said, "I can do that! But when the mother-in-law says, 'Shouldn't she get up on the table now?' I say, 'No, it's not time yet,' and I encourage her to keep walking around or to rest comfortably in my big double bed. Most of my mothers give birth sitting, kneeling, or squatting."

Today, traditional Mexican midwives are striving to create midwifery as both an emerging profession and social movement. Many have birth centers attached to their houses, complete with autoclaves, sterile equipment, and dopplers. Their walls are covered with laminated diagrams of the female reproductive cycle, and their shelves are filled with homeopathic remedies and herbal oils and salves. Dancing fluidly at the interface of biomedicine, holistic alternatives, and traditional birthways, these midwives are creatively producing a hybrid and increasingly well-articulated knowledge system of their own.

Increasingly, health organizations and governments are recognizing that they can effectively partner with midwives to deliver care and improve community health. For example, in recent years the Egyptian government embarked on a program to compliment dayae (traditional midwives) knowledge with modern training, to ensure access to sterile supplies, and to establish relationships with hospitals and physicians who could be called in to cope with emergencies. The result was a stunning 50% decrease in maternal mortality in rural areas over the course of eight years.

Acknowledging that midwives can be a crucial line of defense in educating about HIV/AIDS, the International Confederation of Midwives and the Netherlands Medical Knowledge Institute have recently launched a global AIDS initiative called "Promotion of HIV and AIDS prevention, treatment, care and support," which will train an estimated 100,000 midwifery trainers in 38 countries worldwide.

Contemporary midwives hold the promise of a world of health for all in their hands, even though today nothing is easy about being a midwife. Yet motivated by a shared desire to offer viable long-term birth options, these daughters of time and tradition continue their struggle, always with the necessary determination to make sure that midwives, with all their limitations and all their power, remain available to care for the mothers and babies of the world.

ABOUT THE AUTHOR:

Robbie Davis-Floyd, PhD, a cultural/medical anthropologist specializing in the anthropology of reproduction, is a Senior Research Fellow in the Department of Anthropology at the University of Texas, Austin. Her research on global trends and transformations in health care, childbirth, obstetrics, and midwifery is ongoing. www.davis-floyd.com

Contributions from Malaika Basé and Evelyne Ello-Hart