Variations of midwifery
The practice of midwifery in any one place is conditioned by a wide set of social, economic, and symbolic considertations that give it particular shape and meaning.
Women in India are highly subordinated.
Traditional birth attendants are usually described as supportive and sisterly whereas as for Western birth attendants, professional medicine dominates.
Oakley's five aspects of childbearing:
- cultural definitions of pregnancy and childbearing
- who controls the management of childbirth
- the location of labour and delivery
- labour and delivery positions
- the degree of intervention in birth and the emotional and social supports for the labouring woman.
Women and medicine
Direct consultations during pregnany are very uncommon: wealthy women are constrained by their shame; poor women cannot afford the fees and all women have limited time for consultations.
During the 19th century atleast, women had their symptoms described by another woman or related man, but the male healers could not touch or examine a pregnant or delivering woman.
Dais can attend and do: over 90% of all deliveries in North India have a dai present.
Women, property and kinship
Young married women are valued for three reasons:
- as wealth-bringers (through marriage, the groom recieves a dowry which is not returned to the woman if the marriage fails).
- and bearers of children.
They work long hours but largely undervalued and done in the domestic compound rather than in the fields (unless it is owned by her marital kin).
Cooking, cleaning, rearing children, maintaining courtyards and grain stores, collecting fuel, conversion of cow-dung into fertiliser. Men regard this work as demeaning.
A woman has little say in who she marries. She begins at a low level with her in-laws, offering sexual services ot her husband and respect and work to her mother-in-law. The birth of her first child begins to raise her status.
Shame, pollution and vulnerability / danger.
A woman must not publicise her sexual relationship with her husband. However, pregnancy provides dramatic evidence of sexual activity. Because of this, during pregnancy a woman should cover her body even more assidously. Others will acknowledge her condition by bowing their heads when they see or meet her.
2. Childbirth pollution
The blood lost in childbirth is considered more polluting than menstrual blood.
The baby's firts hair is considered to be contaminated with this blood and so is shaved off.
Touching the amniotic sac, placenta, and cord (collectively know as the "lump"), delivering the baby, cutting the umbilical cord and cleaning up the blood are all cond=sidered the most disgusting of tasks and are defiling: these are the concerns of the dai.
Women feel disgust at touching a newborn. Likewise, the mother is temporarily untouchable and anything she cooks is considered dangerous. She may not have sexual intercourse with her husband for a number of weeks after the birth, and another woman sleeps beside her to ensure her husband does not approach.
3. Vulnerability and danger
A profuse flow of blood after birth is necessary to cleanse the woman. Nowadays few Muslim women are bathed daily because there is no resident dai. A woman may go several days at a time between bathing as she requires her mother-in-law to assist her.
The placenta is a potent source of danger to the newborn baby. They are buried outside and in a hidden place so that a barren woman may not find it and perform magic with it to enable her to conceive. This would harm the baby.
Thus, although the arrival of a new baby may be cause for celebration, local understandings of birthing must be acknowledged. The belief that the jacha is a danger to herself and to others, the belief that she is in a state of vulnerability, and the view that childbirth is shameful all affect other aspects of the birth experience.
Attending birth and managing labour
Childbirth is unsuitable for male involvement. It demeans the man and shames thre woman. If she labours during the day, they may not even be aware of her situation. It is considered a matter for the in-laws.
Unmarried girls who should nto learn about shameful matters before marriage are also excluded. Despite this, a labouring woman is rarely alone. There will be a senior attendant present who may try to hasten slow deliveries by trying various traditional remedies. Others too may suggest measures. But the labouring woman has little say. She may refuse a chosen treatment but management of the labour is not in her hands.
Even after the dai arrives, the senior attendant remains central. She reserves the bulk of the decision making after the birth too, expecting the dai to carry out her orders.
It is thus inapprpriate to consider the dai as a midwife, for even in the absence of medical training, the dai still does not have overriding control although she may have atended hundreds of births.
1) Senior attendant
3) Labouring woman just responds.
Majority of deleveries are home births. A woman shold be in her hsbands home. Her natal kin are excluded from the birth and the celebrations. Their only role is to provide gifts for the jacha and her marital kin.
The labouring woman's birth is managed by altering her positions. There's lots of different research on this topic.
Two-thirds of informants lay down under a quilt during their deliveries and a few squatted in bricks (increases woman's strength). However, most women delivered on their backs.
Cleansing occurs after birth not before: the dai does not shave the public hair, or wash either herself or the woman.
Some say prayers or send money to mosques or recite the Qu'ran over lumps of sugar which the woman then eats.
The woman's plaited hair may be undone to release tension for loose hair is a symbol of sexual heat associated with the opening of the cervix during intercourse.
The woman is commonly given "hot" foods: warm milk with almonds or eggs, dried grapes or gruel.
Intense pains are thought necessary and so are not reduced by any remedy. Women are considered shameless if they make audible sounds. Since pain is inevitable they should merely call on Gid's name. This suggests that women obtain little emotional or social support during delivery.
"The rituals surrounding birth make female physical sexuality seem low status and degrading. Birth isolates women from one another, from their own caste mates and it is not seen as a source of prestige or power."
Midwives or menials?
Why do dai's do the work they do?
Women should be dependant on thier men folk. Only women with no male support and in poverty would even consider taking up this job. Almost all dai's said they have this job out of economic necessity.
"I do it because I have to."
"When I became a dai my sons thought very badly of it. But I replied that without work, how could I eat?... Since I started it my son-in-law has never visited me."
Few dais are literate or have any formal training. Thus they are not considered to posess any esoteric knowledge or specialised techniques.
She is expected to accept the cash given to remove inauspiciousness, but risks acquiring the bad luck herslef. She is not a respected professional who can propse a standard fee for service or enforce claims.