Traditional childbirth

Traditional Childbirth

Behind the pile of soft cloths where the woman is sitting, the curtains are drawn. The glow of a fire lights the room. Beside the woman sits another, who is reaching around her shoulders and holding her hand. In back of the woman sits a third, who encircles her waist, massaging her belly. The woman is moaning softly, but mostly she is concentrating, eyes closed, on the ripples passing regularly through her belly. One of the helping women starts to sing slowly; the rhythms echo those of the birthing woman's body.

The scene could be a tribal village nearly anywhere in the world, in the days before contact with technology. The woman could be Hopi, Balinese, Wolof, or Nepali. The helping women sitting with her could be her mother and grandmother, or an aunt, or perhaps the village midwife.

How did women manage before the advent of modern medicine and natural childbirth courses? What was a real "natural childbirth" like? How much outside help was needed? These are important questions to address in today's technologically oriented birthing world.

Tribal Women and Childbirth

The first European explorers told wondrous tales of childbirth in other lands. In 1791, a traveler among the Guiana women of South America noted, "When on the march an Indian is taken with labor, she just steps aside, is delivered, wraps up the baby with the afterbirth and runs in haste after the others."(1) Priests who traveled with the first expeditions to North America commented that childbirth among the tribal women was a "short and easy affair": "If a woman was traveling by canoe, she asked to be put ashore, entered the woods alone, returned shortly with the newborn, and resumed her share of paddling until the end of the journey."(2)

Complications were rare. Adriaen Van der Donck, after visiting North America in 1641, said of the women, "They rarely are sick from childbirth, suffer no inconveniences from the same, nor do any of them die on such occasions."(3) And in Fiji in 1890, "accidents of childbirth" were said to be "rare."(4)

Recovery was quick. As one writer commented upon visiting the Ila-speakers of northern Zimbabwe, "To those accustomed to the usages of civilization it comes as a shock to see a woman rise up and carry her child, half-an-hour old, back to the house from a shelter in the forest."(5) Likewise, an expedition to South America reported seeing Yamana women "a quarter of an hour after the event [childbirth] going about their work of rowing, gathering shellfish, lifting loads, as though nothing had happened."(6)

Modern society's idea of the complexity of childbirth has evolved partly in response to the changing conditions of society. Periods of urban crowding, epidemics, lack of sunlight, uncomfortable clothing, and malnutrition gave rise to more complex therapies for dealing with the childbirth complications of the times--the childbed fever, convulsions, edema, and hemorrhaging. However, tribal childbirth practices remained basic and simple because tribal lifestyles remained basic and simple.

Traditional Practices

Active pregnancies. Tribal women were physically active throughout pregnancy. Since no custom prescribed "being careful" in the last few months, pregnant women maintained full physical participation in the community and its work.

The tribal woman exercised her whole body, which enabled her to keep physically fit during pregnancy. The Jukun-speaking women of Nigeria continued manual work: cooking, pounding grain, and fetching water from the river or firewood from the bush. Among the Semang of Malaya, the pregnant women went "daily with the other women into the forest in search of food." Pregnant Navajo women of Arizona would run footraces before sunup when the snow was deep!

Pregnancy diets. Tribal women avoided fats and sugars during pregnancy. The only known sweets--honey and, in some places, sugarcane--were strongly prohibited. As it was said among the Akamba of Kenya, "The child is supposed to derive a great nourishment from the honey and become so large that a successful confinement is almost impossible."(7) In some places, milk was avoided during pregnancy; in others, dairy products were absent from the diet altogether. (Keeping cattle is a fairly recent development that many groups still do not practice.) In addition, meats and spices were kept to a minimum. Diets during pregnancy were largely vegetarian. Staples included grains, vegetables, fruits, and nuts.

Positive attitudes. Tribal women did not see childbirth as a time of helplessness, nor did they have their babies "delivered" by specialized practitioners. Tradition taught that the woman herself was the most important agent. Culturally prepared to carry out the birth of her children, the tribal woman maintained a positive and trusting attitude throughout her pregnancy.

In numerous societies, women gave birth with no assistance at all. Among the Chukchees of Siberia, where babies were born "with little trouble," the mother attended completely to her own needs and those of her newborn. She cut the umbilical cord and disposed of the placenta herself. The Fulani women of Africa were accustomed to catching their birthing infants in their own hands!

In other societies women were attended during birth by relatives and friends. Most often, the main birth assistant was the woman's mother. If she was unavailable, another woman from the family would help--a grandmother, aunt, sister, or more distant female relative from the clan.

Tribal women often gave birth in the fields or wherever they happened to be when contractions began. However, in North America and in some parts of South America and Asia, women built--or had built for them by their female relatives--a "nesting house," as the Maori called it. In other parts of the world, women gave birth in their own homes. Since tribal women did not leave familiar and comfortable surroundings during labor, birth flowed easily, progressing at its own speed.

Activity before birth. Many tribal women engaged in physical activity to stimulate labor. In Senegal, Wolof women walked and pounded grain in a mortar to bring on their final contractions. The Bakitara women of Uganda worked in the fields until labor began, "and they would sometimes bring it on by lifting a waterpot or a bundle of fire-wood."(8) In the preindustrial Balkans, where the women walked continuously during labor, babies must have been born swiftly, or straw was typically spread on the stone floor to protect the child's head.

Nourishment during labor. A deeply rooted prohibition against food and drink during birth existed in many traditional societies. The Tiwi of Australia remarked that food "slows" the birth, and the Jukun-speakers of Nigeria said that it "hinders" birth. However, most tribal mothers who felt a strong desire for food or drink were not denied. In fact, the Hottentots of South Africa and the Chagga of Tanzania drank warm soups from time to time while birthing.

Protection of the perineum. Episiotomy, or the cutting of slits in the perineum, was rare in the tribal world. Instead, various measures were taken to relax the perineum, ensure its softness and flexibility, and allow it to stretch and accommodate the infant's eventual passage. The Buganda women of Uganda sat in shallow baths of herbal preparations during the last few weeks of pregnancy to relax the tissues of the perineum. In nearby Sudan, the women would squat over a pot of herbs on the fire; this form of steaming moistened and softened the perineum and was "held in great repute for making labours easier."(9) Moroccan women washed the vulva daily throughout pregnancy with hot salted water; just before birth, they took steam baths to make their tissues supple.

Topical applications were also common. In Japan, India, and Thailand, women lubricated the perineum with oil just before birth. The Kgatla of Botswana used fat "to loosen the skin and prevent it from splitting." Other communities used local plant-based preparations to soften the perineal tissue. For instance, the Wayao of Malawi applied a decoction of tree bark, the Fang of Africa applied a slippery-smooth sap mixture, and the Mexicans of Michoacan used the moist, inner part of the "nopal" (prickly pear cactus fruit). Use of these emollients made perineal tears less likely, and any small, natural tears that may have occurred healed quickly.

Birth positions. The birthing positions of our foremothers utilized the force of gravity and also shortened and widened the pelvic outlet. The most popular position throughout the world was sitting with knees bent, leaning back on someone or something for support. Other traditional positions included kneeling, squatting, and standing up. All birthing women were supported in one way or another, often by hanging onto ropes, wooden poles, horizontal bars, people, or tree branches. Lying down for birth was generally avoided. The Cahuilla of California believed that an upright position prevented piles, and in India it was said that "if you lie down, the baby will never come out."

Correcting the baby's presentation. The traditional birth assistant did not "catch the baby." Her major duties were to provide physical support for the positions chosen by the mother, and to massage the mother's abdomen (especially during contractions) and sometimes her back, legs, and thighs. Massaging eased the birth process and also prevented or corrected such malpresentations as breech or transverse positions. External version (turning the baby by externally manipulating the abdomen) was commonly practiced during the last part of pregnancy and during birth itself. It was noted of the Negritos of the Philippines, for example, that "the ministrant's relatives or the same skillful woman whom we may call midwife has so manipulated the foetus that it nearly always makes its entry into the world head first."(10)

Delivery of the placenta. Standing, stretching, and uterine massage were often used to facilitate expulsion of the placenta. In Lesu, New Ireland, the new mother went to bathe in the sea immediately after birth, rubbing her abdomen with a downward motion to expel the placenta. A simple method for expelling an unduly delayed placenta was practiced in Morocco. Here, the maternal end of the cut umbilical cord was soaked in a container of hot oil. Several minutes after treatment, the mother reportedly stood up, and the placenta simply fell out!

Care of the newborn. In the majority of tribal societies, the umbilical cord was cut only after the placenta was expelled and the baby was breathing normally. In Tahiti, for example, "the infant was allowed to cry long and breathe freely so as to receive full life from...[the] mother" before the cord was cut. It has recently been recognized in modern society that cutting the cord after it stops pulsating can shorten the third stage of labor, prevent hemorrhaging from the cord end, help the infant establish breathing, and contribute to the newborn's long-term health.

In a number of societies, the placenta and cord were never separated. (The cord sloughs off by itself in two to 10 days, often around the fourth or fifth day.) Some tribal groups used the attached placenta to care for newborns who had difficulty breathing. They would give the baby an extra infusion of blood by squeezing the cord toward the infant. They would also manipulate the placenta to provide stimulation to the child. In Thailand, they pressed a heated iron against the placenta; in the Philippines, they placed the placenta on coals and rubbed it; and in Morocco, they put the placenta in a container of hot water and massaged the cord.

The following account is from the Maikal Hills in India: "Life passed through the cord into the flower [placenta] and the child went cold. We brought two handfuls of grass from the roof and placed the flower on it, and lit it. As the flower grew warm, life flowed back into the child."(11)

Many tribal communities welcomed babies in warm, quiet, darkened rooms. Slapping the baby was not a common practice, although babies were sometimes held upside down to clear the passage to the lungs. In some places, babies who did not begin breathing spontaneously were given cold baths. Even babies who were breathing well were sometimes given a sprinkling of cold water to ensure hearty respiration and then a warm bath. Because soap was used rarely in newborn care, it is likely that the vernix caseosa--the white, greasy substance covering the newborn's skin--was preserved for its protective measures.

In traditional cultures, children were often aware and responsive from the moment of birth. One witness of a tribal birth in Mozambique wrote, "The newly born baby seemed most intelligent. She looked as if she were quite used to this old world and the sunshine and the wind and the faces smiling at her."(12)

Recovery. Postpartum recovery was considered an important phase of childbirth, and tribal women had a variety of recovery techniques at their disposal. One of the most important of these was massage. Massaging helped expel placental remnants from the uterus. It also helped shrink the uterus to its former size and shape.

Another important recovery technique was physical activity. The average tribal woman was physically active shortly after birth. Indeed, it was customary to stand up at once. Our tribal foremothers may have known that the way to prevent the formation of blood clots (which can lead to hemorrhaging) is to get up and move around within the first few minutes of the after-birth period. Kickapoo mothers in Mexico walked back and forth after birth "to prevent hemorrhaging." Native American mothers of Oregon stayed on their feet during most of the first day; they took short walks and leaned forward, pressing the abdomen against a staff to facilitate the flow of blood. According to a 1908 report of the White Mountain Apache of Arizona, unless the mother was too weak after birth, she ran about among the bushes outside the hut so that "the blood may not clot."

Bathing was also a form of traditional postpartum care. The Yamana women of Argentina went to the shore to wash, stepping into the water as far as possible and rubbing their bodies thoroughly with a ball of moss. The nearby Araucanians waded into the cold, deep water of a stream, sometimes breaking through thin ice to bathe after birth. New mothers on the West Coast of Africa first took a massage and then walked to a stream and sat in it for a considerable period of time.

Abdominal binding helped support the new mother's abdomen. This practice was so widespread that in some places any strip of cloth, rope, or other material around a woman's waist signified that she was a new mother. Abdominal binding ensured the complete drainage of blood and aided the contraction of the uterus.

Tribal women did not attempt to prevent after-birth bleeding. Rather, they encouraged an abundance of postpartum discharge. When resting, many assumed a half-reclining position to promote the flow of blood. Japanese women traditionally rested with the head slightly elevated on a stack of pillows; each day more pillows were removed, until the head and body were level.

The use of heat and warmth after childbirth was nearly universal. Throughout the tribal world, the new mother sat or lay by a fire or in a heated sand bed for a period of time. Among the Hopi of Arizona, the new mother rested on layers of soft cloths kept warm by heated sand. Hot rocks were placed at her feet and near her legs for additional warmth. Heat treatments helped dry up the discharge, shrink the uterus, prevent hemorrhaging, provide relaxation, and stimulate the production of milk for the baby.

Traditional approaches to childbirth were simple, effective, and consistent with other aspects of the tribal life pattern. Giving birth provided a great reward for tribal women because the process remained within their control and understanding. Although times have changed, the process of birthing has not. Using the wisdom of our foremothers, we can learn old ways to influence new births. Notes (1)Walter E. Roth, An Introductory Study of the Arts, Crafts, and Customs of the Guiana Indians. US Bureau of Ethnology 38th Annual Report (1916-1917). (2)Wilson and Ruth Wallis, The Micmac Indians of Eastern Canada (Minneapolis, MN: University of Minnesota Press, 1955). (3)Adriaen Van der Donck, A Description of the New Netherlands (Amsterdam, 1656). (4)Basil Thomson, The Fijians (London, England: Dawsons of Pall Mall, 1908). (5)Edwin W. Smith, The Ila-Speaking Peoples of Northern Rhodesia (London, England: Macmillan, 1920). (6)Carlos Spegazzini, "Costumbres de los habitantes de la Tierra del Fuego," Anales de la sociedad cientifica argentina 14 (Buenos Aires, 1882): 159-181. Quoted in Martin Gusinde, The Yamana: The Life and Thought of the Water Nomads of Cape Horn (New Haven, CT: Human Relations Area Files, 1937). (7)Gerhard Lindblom, The Akamba in British East Africa (Sweden: Uppsala, 1916). (8)John Roscoe, The Bakitara of Banyoro (Cambridge, England: Cambridge University Press, 1923). (9)Robert W. Felkin, "Notes on Labour in Central Africa," Edinburgh Medical Journal 29 (1884). (10)John M. Garvan, The Negritos of the Philippines (Vienna: Verlag Ferdinand Berger, 1964). Fieldwork conducted from 1907 to 1924. (11)Verrier Elwin, "Conception, Pregnancy and Birth among the Tribesmen of the Maikal Hills," Journal of the Royal Asiatic Society of Bengal 9 (1943). (12)E. Dora Earthy, Valenge Women (London, England: Frank Cass & Co., 1933).

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