By Dorothy McKune
Executive Director
December 2011
Alliance of African Midwives
Women have played a very integral part in the reproduction field in the past, and continue to do so in the present. Since the beginning of human civilization women healers honoured and observed the sacred cycles of nature, time, and spirit. Women healers served their communities through midwifery, spiritual healing, nutritional and herbal healing, massage, hands on healing, prayer, ritual, dance, song, music, toning, and dreaming. Wise women healers offered healing support for their communities through ceremony and nurturing care from birth to death, from “womb to tomb.”
Few traditions have continued throughout the ages as has the practice of midwifery. Everybody agrees that Midwifery is one of the world's oldest professions. Tracing midwifery history through ancient history is somewhat difficult due to scarcity of written material. The earliest recorded mention of midwives is contained in the books of Genesis and Exodus in the Holy Bible. The Book tells of a delivery aided by a midwife, and the mother’s subsequent death; a midwife’s care at a successful twin birth; and finally, the time in Egypt where the midwives were commanded to kill all infant boys. From these accounts, it can be implied that midwifery was a common and usual part of life in that time.
Among the many roles of the traditional midwife is a pregnancy diagnosis, assessment of nutritional intake, counseling regarding the side effects of pregnancy massage of the abdomen, delivery, assessment of the newborn, cord care and cultural rituals. After delivery the traditional midwife makes home visits to follow up on vulnerable populations and encourage use of family planning to space births.
Although Traditional midwives have been helping women birth since the beginning of time, their ways have not changed, only the society we live in.
Traditional Midwives know that birthing is natural and a woman has the ability to birth simply and safely. These midwives have never relied on machines, drugs and the modern technology to help with birth.
Traditional midwives (TM) are the key for the future of Africa. Most African mothers living in rural areas cannot afford transport to the modern hospitals and clinics in urban districts, so they rely on the expertise of Traditional midwives to help them through the process of giving birth. These traditional midwives assist with births, but also cared for the sick. Usually these women used herbs and other folk remedies in their treatments. Traditional midwives have not changed their ways. They know that birthing is natural and a woman has the ability to birth simply and safely. Most of the great people of Africa such as Nelson Mandela, Archbishop Tutu and many others are alive today because they were born into the hands of traditional midwives. Without the support of midwives, many mothers would not get the proper care during and after their pregnancy. These midwives use herbs and other folk remedies in their treatments.
African women always give birth in in a squatting position which is now used in western hospital with a claim to it. The birth canal will open 20 to 30% more in a squat than in any other position. Contrary to this practice, almost all women who give birth at health-care facilities do so in supine position and sometimes with legs in lithotomy.
Western medical practices displaced traditional midwifery, the touch and massage of a midwife was the central component of prenatal care around the world. A traditional midwife has her eyes, ears, and hands to diagnose and assist pregnant women and never rely on technology. Because of the constant practice the TMs senses of observation and intuition through touch were finely tuned. Today, traditional healers and midwives skillfully integrate the ancient healing arts of massage and midwifery, as they have for thousands of years. Yes, TM' techniques include massage and manipulations, herbal concoctions, rites invoking goddesses and spirits, sharing of birth experiences, emotional support and nurturance.
But things start to change during the nineteenth and twentieth centuries when African was colonized.
Biomedical obstetrics took over much of the care and “management” of pregnancy and birth. Western medicine has certainly introduced some life-saving skills but sadly, it has also contributed to the eradication of traditional midwives. The early British combination of nursing and midwifery has long been the model for the profession of nurse-midwifery in the African continent, but many western countries have come to critique this model because education in nursing first tends to heavily socialize midwives into the hierarchical, interventionist biomedical model of birth.
The media brainwash us into thinking that us women need the help of trained medics to control something that is 100% natural.
The hospitalisation of women originally rose from a disagreement between obstetricians and midwives about intervention: the obstetricians (largely male) were pro-intervention and the midwives (largely female) against. It was a political battle of wills in order for males to dominate an otherwise female occupation.
One direct result is that the rates of obstetrical intervention in birth are rising worldwide. Just a little over a century ago, in 1900, midwives attended half of the births in the US, and only about 5% of births happened in hospitals. By 1939, about half of women gave birth in hospitals, virtually all with twilight sleep. By 1960, 97% of births happened in hospitals. Why the dramatic change? Was it because hospital birth was safer?
What we have now is a society where women are terrified of birth, they have a terrible time as a result, they seek answers from career medics rather than trusting their instinct, on occasion they will accept bad advice, feel frustrated and anxious during labour because they are told to trust the midwives instead of their own bodies, and generally have a crap experience.
I've never heard that from a homebirth mum. Choice is crucial and home births should be a very real and encouraged option.
As a childbirth educator I have worked in many African countries, preparing women and couples for unmediated, conscious births. I became frustrated with unnecessarily brutal obstetrics and turned to the traditional knowledge of women's health, pregnancy and birth. This knowledge is not textually based. It is transmitted through apprenticeship and reinforced by being part of local ritual, religious, herbal and healing customs.
Many African women live far from health centres and which means they make the long and costly trip only to find discrimination by health professionals who do not speak their language or may hold strong prejudices about them. Sometimes women find that hospital practices go completely against their cultural norms. That is why women and their families often have more confidence in traditional birthing practices than in modern medical techniques that is so often forced onto African women. The nurses yell at the patients, mock them, demand money from them, and exhibit such a hideous bedside manner that medical services are underutilized.
Today there is a re-claim to the midwifery model by the same countries that try to eradicate it. Such critics have worked to generate or regenerate direct-entry midwifery, in which midwives should not be nurses first, but instead are educationally grounded in the midwifery model of care.
The International Confederation of Midwives (ICM) held their first conference on African soil on June 19-23 in Durban South Africa. ICM is trying to regulate and control midwifery around the world and ask individual countries to become members. ICM is highly critical of traditional midwives and as such does not include them in their definition of a midwife.
What are Traditional Birth Attendants?
Traditional Birth Attendants (TBAs) are common in many parts of the world. Attendants usually learn their skills from older attendants in the village, and for many families in remote areas and indigenous communities, they are the first port of call when giving birth.
They are often called on when a woman starts to deliver or if she starts to have problems. Attendants often act as a source of general information for women, and may give advice before or after birth about cultural traditions. If trained, they might also provide nutritional advice.
While attendants generally perform a valuable role, if they are not trained there can be some dangerous practices. For example in some African countries, one practice is for the midwife to massage the stomach to try and induce the birth. However, this can lead to the umbilical cord strangling the baby. In Sierra Leone another practice is to sit on the mother’s stomach to induce the birth, but this can lead to injury to the woman’s birth canal.
Maternal morbidity
In 1987, WHO launched the Safe Motherhood Initiative, which aimed to reduce maternal morbidity and mortality by 50% by the year 2000. In 2000, world leaders came together at the UN to adopt the United Nations Millennium Declaration, which identified eight anti-poverty goals to be accomplished by 2000, which we know now was not the case. The initiative did not succeed and maternal health continues to be a major focus of WHO efforts. The World Health Organization (WHO) defines a “traditional birth attendant (TBA) as a person who assists the mother at childbirth and who initially acquired her skills delivering babies by herself or by working with other birth attendants. So, that says it all, that the WHO does not recognize the traditional midwife as a midwife, but rather as a Traditional Birth Attendant. The WHO suggests that TBAs are stopgap measures until more “qualified” personnel are available and indeed, traditional midwives have been largely eliminated or greatly reduced in number and scope.
Traditional Birth Attendant is a derogatory term for an African midwife. In Zimbabwe they have not used the term TBA because traditional midwives are a necessary part of the health care system. Zimbabwe has a dual health system where doctors and nurses practice and one where traditional midwives in health beliefs and practices that is suitable to the communities they serve.
The African continent is facing many challenges such as maternal mortality. Traditional midwives are the key to the birthing system in rural Africa. African women are pushed to give birth in healthcare centres. Most African mothers living in rural areas cannot afford transport to the modern hospitals and clinics in urban districts, so they rely on the expertise of Traditional midwives to help them through the process of giving birth. Many African governments under pressure by the World Health Organization to encourage women to deliver in hospital.
Traditional midwives have no such formal education; they suffer multiple forms of discrimination within biomedical systems. Hospital midwives look down at traditional midwives. Anthropologist Robbie Floyd Davids explains why this crisis continues to deepen. The article by Robbie Davis-Floyd will help you understand the basic issues facing traditional midwives and why women still prefer the care of these midwives. If women go to the healthcare settings they face obstacles from overworked, understaffed nurses and midwives.
Women have lots of stories to tell, and they tend to be excellent story-tellers. When traditional midwives get together and tell stories, they are sharing important aspects of what they learn and how they learn it, of what they know and how they use that knowledge and they pass on valuable information to the next generation of Africa. For now, until there is improvement to roads, healthcare centres and adequate staffing, traditional midwives will stay with us for a long time.
Davis-Floyd, R, Pigg, S. L., Cosminsky,S. (2001). Daughters of Time: The Shifting Identities of Contemporary Midwives. Spec. issue, Medical Anthropology 20 (2–4).
Lavender, T., Mlay, R. (2006). Position in the second stage of labour for women without epidural anaesthesia: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization.
World Health Organization. (1975). Geneva. Retrieved from: http://whqlibdoc.who.int/offset/WHO_OFFSET_18.pdf
http://bible.cc/exodus/1-19.htm