Tuesday, February 20, 2007

Global midwifery

I'd like to follow up on the previous post about direct entry midwives and traditional birth attendants. DEMs pay a great deal of lip service to traditional birth practices but their practice is quite different. Furthermore, they draw a distinction between traditional knowledge which is the province of midwives from third world countries and modern, scientific knowledge which they believe belongs exclusively to midwives from first world countries. Simply put, they actually look down on traditional birth attendants.

Maria Fannin explores this in her paper Global Midwifery and the Technologies of Emotion. As she says in the introduction to the paper:
This paper examines the emergence of activist organizations promoting midwifery as a “global” practice. New organizations like the International Alliance of Midwives link individual midwives and midwifery advocates through Internet based chat rooms, websites, and discussion lists... By examining the “global” as a site of emotional investment, I demonstrate how midwives’ attempts to map “tradition” and “technique” reveal attachments to particular ways of imagining the world.
Fannin examines the attempts of the founders of Midwifery Today to establish a global network of direct entry midwives:
In a 1999 editorial ... editor Jan Tritten writes that the new “Global Alliance of Midwives” (later to become the International Alliance of Midwives or IAM) will be an alternative network to the largest international organization then in existence, the International Confederation of Midwives...

[According to Tritten]:

Our definition of a midwife must include the traditional midwives who are so insensitively and derogatorily called TBAs [traditional birth attendants]. We must honor and learn from all our colleagues. Think how fertile an organization could be if it is inclusive. Our information exchanges could only get richer as we present good midwifery research side by side with the thousand-year-old traditions many of the world's midwives still use.
Yet, the reality of International Alliance of Midwives has been very different than envisaged. Fannin, attending conferences of the IAM to research midwives attempts at creating a global organization found:
... One of the sessions at the conference was entitled “Tricks of the Trade.” This session was designed to be an open forum for exchanging stories of midwives’ work and the skills they rely on to manage difficult situations. An organizer ... solicited volunteers to share their “tricks” with the audience. As the session opened, the organizer turned to the two midwives in attendance from Haiti, asking them to share, in her words, the “traditional” methods they used to resolve problems that might arise before, during and after a birth: a breech baby, a prolonged labor, nervous mothers, problems with breastfeeding and so on. They responded that they did not know any traditional methods. The rest of the audience seemed awkwardly disappointed ... [I]n the course of a two-hour discussion ... two midwives from Russia were also asked about “traditional” methods, but interestingly, when other midwives (from Denmark, the Netherlands, Spain, Italy) were asked to share their “tricks,” the question was framed differently. Midwives from these places were asked about “techniques that worked.” The choice of language seems instructive.

In calling upon Haitian and Russian midwives to share “tradition” while midwives from Western Europe and North America were asked to share “techniques,” the implications for who was situated as the bearer of traditional knowledge and who held modern, scientific knowledge was clear...

I interviewed one of the two Haitian midwives from the “Tricks of the Trade” session later in the day and asked her about her training. She responded that both she and her colleague were educated as nurses and taught at a school for professional midwives in Port-au-Prince. And it was only in passing that her colleague, who had trained as a nurse in Haiti and as a midwife in Switzerland, told me that the self-taught or “traditional” midwives practicing in rural Haiti refused to share their practices with her...

Yet, the “traditional” midwife’s refusal to share is rarely heard within the arena of international cooperation and exchange that characterizes the grassroots yet global midwifery project and that elicits tradition from specific subjects. Not hearing the reason for this refusal effaces an important analysis of the relations between midwives subsumed under calls for global midwifery ... as well as the commodified cultural knowledge of “alternative” birthing practices marketed to eager consumers of “tradition.”
Fannin concludes:
New online organizations like the International Alliance of Midwives ... constitute midwives as world citizens of a global village. At conferences and workshops ... the reiteration and performance of midwifery’s globality enacts hierarchies of cultural exchange. Cataloging cultural difference becomes a means to “feeling global,” yet these feelings also map a telos of modernity, from “tradition” to “technique,” across nations and bodies...
So while DEMs claim that their practice is derived from midwifery "tradition", they actually posit a difference between traditional practice and modern knowledge. In contrast to midwives from third world countries, who they imagine to be the bearers of tradition, they consider themselves as possessing modern scientific knowledge. It is all the more ironic that midwives from third world countries practice based on scientific methods, and that traditional birth attendants do not want to have interaction with direct entry midwives.


0 Old Comments: