Review

Carry on delivering

BIRTH WITHOUT DOCTORS: CONVERSATIONS WITH TRADITIONAL MIDWIVES
Jacqueline Vincent-Priya
Earthscan Publications, 1991, £7.95

Birth without doctors is an event that women in Britain have to fight to achieve, but the same is not the case world-wide. Most rural Third World women deliver their babies themselves or with the help of traditional birth attendants, although as the book shows, this is changing, with women being pressed into using government midwives and hospitals.

The title aptly describes the contents, viewing childbirth in the social/cultural sphere. For this reason, Birth without doctors has an important place in the historic debate over women’s loss of control over childbirth, and the move towards medicalisation of birth. Vincent-Priya points to the irony that in the West we are just realising the importance of using midwives’ skills and women’s involvement in birth in order to achieve successful outcomes in women’s terms; in developing countries, the influence of the West means that birth is becoming more medicalised, and traditional midwives’ skills are being lost.

The author has sympathetically recorded her conversations with traditional midwives in Malaysia and Indonesia, including the minutiae of daily life, as well as customs, habits and beliefs of the people. She gives examples of woman-led childbirth, requiring acknowledgement and understanding of the whole context of women’s lives, that will make struggling midwives smile. It is common to read that women themselves decide what they want: for example, in labour, ‘sometimes they squat, sometimes they lie down -- she can do it whatever way is comfortable’; and ‘every woman knows how to look after herself when she’s pregnant’.

But the intervention of state medicine hovers in the background, and Vincent-Priya sensitively interprets the conflicts that result. One issue is the dual identity of the traditional midwife, on the one hand condemned by the medical establishment for her ‘barbaric practices and insanitary techniques’, and on the other a respected member of the community, with a valuable role in the continuation of traditional ways. While government midwives are seen as outsiders, wealthier than village workers, their practice often not meeting the needs of women, it is recognised that they have powers in emergencies, making it necessary for women to register with them.

This book is a valuable historical record, providing evidence that traditional midwives still practise widely, maintaining women’s autonomy and providing an important service for poorer women, although their skills are steadily being eroded. It reminds us of what we have lost in the medicalisation of childbirth.

The author acknowledges her role as researcher and outside force in the conversations, which may have influenced what she was told. She calls for more research on traditional practices, pointing out that traditional ways are undermined by criticisms based on unresearched evidence.