Daughter of time: the postmodern midwife (Part 1)

Este artículo busca conceptuar la partera pos-moderna, definiéndola como aquella que tiene una postura en relación a la biomedicina y a otros sistemas de conocimiento, moviéndose fluidificado entre ellos para ayudar a las mujeres que asiste. Es consciente, culturalmente competente y políticamente enganchada. Trabaja con recursos de su conocimiento específico, aliados a los intereses de la mujer. Su relativismo informado es más accesible para las parteras profesionales, pero lo que se observa, alrededor del mundo, es que esta actitud está atingiendo las parteras tradicionales, en diversos países. Así, el concepto de partera pos-moderna representa una puente para las brechas étnicas, raciales y de status, que separan las parteras profesionales de las tradicionales, y un punto focal y analítico para la comprensión de la forma de negociación de identidades y papeles de cada uno de los miembros en el grupo, en el mundo en transformación.This article presents the notion of the postmodern midwife, defining her as one who takes a relativistic stance toward bio-medicine and other knowledge systems, alternative and indigenous, moving fluidly between them to serve the women she attends. She is locally and globally aware, culturally competent, and politically engaged, working with the resources at hand to preserve midwifery in the interests of women. Her informed relativism is most accessible to professional midwives but is also beginning to characterize some savvy traditional midwives in various countries. Thus the concept of the postmodern midwife can serve as a bridge across the ethnic, racial, and status gaps that divide the professional from the traditional midwife, and as an analytical focal point for understanding how the members of each group negotiate their identities and their roles in a changing world.Este artigo busca conceituar a parteira pós-moderna, definindo-a como aquela que tem uma postura realista em relação à bio-medicina e a outros sistemas de conhecimento, movendo-se fluidicamente entre eles para ajudar as mulheres que assiste. É consciente, culturalmente competente e politicamente engajada. Trabalha com recursos do seu conhecimento específico, aliados aos interesses da mulher. Seu relativismo informado é mais acessível para as parteiras profissionais, mas o que se observa, ao redor do mundo, é que esta atitude está atingindo as parteiras tradicionais, em diversos países. Assim, o conceito de parteira pós-moderna representa uma ponte para as brechas étnicas, raciais e de status, que separam as parteiras profissionais das tradicionais, e um ponto focal e analítico para a compreensão da forma de negociação de identidades e papéis de cada um dos membros no grupo, no mundo em transformação

Open and Closed Knowledge Systems, the 4 Stages of Cognition, and the Cultural Management of Birth

This conceptual “think piece” looks at levels or Stages of Cognition, equating each of the Four Stages I examine with an anthropological concept. I equate Stage 1—rigid or concrete thinking—with naïve realism (“our way is the only way”), fundamentalism (“our way should be the only way and those who do not follow it are doomed”), and fanaticism (“our way is so right that everyone who disagrees with it should be either converted or eliminated”). I equate Stage 2 with ethnocentrism (“there are lots of other ways out there, but our way is best”). The next two Stages represent more fluid types of thinking—I equate Stage 3 with cultural relativism (“all ways are equal in value and validity”), and Stage 4 with global humanism (“there must be higher, better ways that can support cultural integrity while also supporting the individual rights of each human being”). I then categorize various types of birth practitioners within these 4 Stages, while showing how ongoing stress can cause even the most fluid of thinkers to shut down cognitively and operate at a Stage 1 level that can involve obstetric violence—an example of further degeneration into Substage—a condition of panic, burnout or “losing it.” I note how ritual can help practitioners ground themselves at least at a Stage 1 level and offer ways in which they can rejuvenate and re-inspire themselves. I also describe a few of the ongoing battles between fundamentalists and global humanists and the persecution that Stage 4 globally humanistic birth practitioners often experience from fundamentalist or fanatical Stage 1 practitioners and officials, often referred to as the “global witch hunt.

Indigenous Midwives and the Biomedical System among the Karamojong of Uganda: Introducing the Partnership Paradigm

Certainly there can be no argument against every woman being attended at birth by a skilled birth attendant. Currently, as elsewhere, the Ugandan government favors a biomedical model of care to achieve this aim, even though the logistical realities in certain regions mitigate against its realisation. This article addresses the Indigenous midwives of the Karamojong tribe in Northeastern Uganda and their biosocial model of birth, and describes the need British midwife Sally Graham, who lived and worked with the Karamojong for many years, identified to facilitate “mutual accommodation” between biomedical staff and these midwives, who previously were reluctant to refer women to the hospital that serves their catchment area due to maltreatment by the biomedical practitioners there. This polarisation of service does not meet that society’s needs. We do not argue for the provision of a unilateral, top-down educational service, but rather for one that collaborates between the biosocial model of the Karamojong and the biomedical model supported by government legislation. We show that such a partnership is practical, safer, and harnesses the best and most economical and effective use of resources. In this article, we demonstrate the roles of the Indigenous midwives/traditional birth attendants (TBAs) and show that not only is marriage of the two systems both possible and desirable, but is also essential for meeting the needs of Karamojong women. The TBA is frequently all the skilled assistance available to these women, particularly during the rainy season when roads are impassable in rural South Karamoja. Without this skilled help, the incidence of maternal and infant mortality would undoubtedly increase. Ongoing training and supervision of the TBA/Indigenous midwife in best practices will ensure better care. We offer a way forward via the Partnership Paradigm (PP) that lead author Sally Graham designed in conjunction with the Indigenous midwives and biomedical staff with whom she worked, the development and characteristics of which this article describes

Birth as an American rite of passage

Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth - routines that can be insensitive, unnecessary, and even unhealthy? And why, in spite of the natural childbirth movement, has hospital birth become even more intensely technologized? Robbie Davis-Floyd argues that these obstetrical procedures are rituals that reflect a cultural belief in the superiority of science over nature. Her interviews with 100 mothers and many health care professionals reveal in detail both the trauma and the satisfaction women derive from childbirth. She also calls for greater cultural and medical tolerance of the alternative beliefs of women who choose to birth at home

Home-birth emergencies in the US and Mexico: the trouble with transport

Proponents of the global Safe Motherhood Initiative stress that primary keys to safe home birth include transport to the hospital in cases of need and effective care on arrival. In this article, which is based on interviews with American direct-entry midwives and Mexican traditional midwives, I examine what happens when transport occurs, how the outcomes of prior transports affect future decision-making, and how the lessons derived from the transport experiences of birthing women and midwives in the US and Mexico could be translated into improvements in maternity care. My focus is on home birth in urban areas in Mexico and the US. In both countries, biomedicine and home-birth midwifery exist in separate cultural domains and are based on distinctively different knowledge systems. When a midwife transports a client to the hospital, she brings specific prior knowledge that can be vital to the mother's successful treatment by the hospital system. But the culture of biomedicine in general tends not to understand or recognize as valid the knowledge of midwifery. The tensions and dysfunctions that often result are displayed in midwives' transport stories, which I identify as a narrative genre and analyze to show how reproduction can go unnecessarily awry when domains of knowledge conflict and existing power structures ensure that only one kind of knowledge counts. This article describes: (1) disarticulations that occur when there is no correspondence of information or action between the midwife and the hospital staff; and (2) fractured articulations of biomedical and midwifery knowledge systems that result from partial and incomplete correspondences. These two kinds of disjuncture are contrasted with the smooth articulation of systems that results when mutual accommodation characterizes the interactions between midwife and medical personnel. The conclusion links these American and Mexican transport stories to their international context, describing how they index crosscultural markers, and suggest solutions, for "the trouble with transport."Childbirth Home birth Midwives Hospital Transport US Mexico

L’intuizione come sapere autorevole nella pratica ostetrica e nel parto a domicilio

Le tecnologie diagnostiche, dai banali e ordinari ultrasuoni ai più esotici trapianti di embrioni, condividono l’obiettivo della costruzione del feto come un essere separato - reificano, rendono quindi reale il feto. Il feto diventa visibile, una presenza percepibile, ma per ottenere questo obiettivo è necessario accettare anche altre due conseguenze. La medicalizzazione della gravidanza e la scomparsa della donna, resa in tal modo invisibile e impossibile da ascoltare. La storia dell’ostetricia occidentale è la storia delle tecnologie di separazione. Abbiamo separato il latte dal seno materno, le madri dai bambini, i feti dalla gravidanza, la sessualità dalla procreazione, la gravidanza dalla maternità. Alla fine ci è rimasta l’immagine del feto come di un essere solitario. che galleggia liberamente come l’uomo nello spazio, con il cordone ombelicale che sembra tenere al guinzaglio un’imbarcazione di placenta e la madre invece ridotta allo spazio vuoto che circonda tutto ciò. E’ veramente difficile ricomporre concettualmente ciò che la medicina ha fatto a pezzi (…) Poiché sto parlando a gruppi diversi, tra i quali si trovano sia studiosi di scienze sociali sia operatori della nascita, mi rendo conto di quanto sia difficile, dando per scontato che il valore della connessione siastato compreso, trasmetterne il significato. <br /