Childbirth was always a women business. Women assisted other women during birth as well as bearing children for thousands of years. Before colonization of Africa, birth happened at home. Midwives have helped women deliver babies since the begining of history. Women were surrounded by female relatives and friends and under the care of a midwife. Men had little knowledge of the birth process or of the female anatonomy. These women were called midwives, and they were in charge of the birth of a baby. The midwife would care for the pregnant women, deliver the baby and provide essential postnatal care for the woman until she is back on her feet to care for herself.
Medicalization of childbirth in the African continent is a crisis that had affect mother babies and midwives. As the western world invaded Africa, things have changed regarding midwives in the African continent. A more technological approach to childcare gained momentum and men were the focus. In the United States around 1939 was the time when more babies were born in hospitals, and this is still rising. While midwives dealt with straighfoward births male doctors were called to intervene, and they used forceps to assists obstructive births. Unfortunately, it is during this time that physicians began to define what normal standards should be for childbirth.
This standards for birth was not because medical science was particularly good at childbearing but because male domination at the time took over the childbirth. Physicians went on a massive advertising campaign, aimed at telling women that other women were not as good at delivering babies as they were. They used the Emmanual Friedman (Friendman’s curve) graphic presentation of a normal labour. One of the most common reasons for cesarean today is due to a failure to progress during labour. Unfortunately midwives were not strong enough to stand up against the mighty machine. The number of doctors specialized in obstetrics increased and at the time all were men. Technology such as cardiotograph machine were introduced and as such the caesarian rate has gone up. More money are spend around the world to perform unnecessary caesarian sections whereas the funds could have been used to improve birthing practices and education of pregnant women. Because of the medicalization of birth in the western world, this practice was forced onto African people.
Today the role of the midwife had changed dramatically in Africa. Midwives in Africa is a dying breed. The working environment of midwives had changed and most midwives worked in hospitals. They carry out most of the deliveries and refer complicated cases to the physcian. Unfortunately these midwives have to be a nurse first and then follow with a one year midwifery diploma. The training of midwives to go to school to learn midwifery is gone and to be able to work as a midwife in most countries, most women must learn nursing first, and then transfer to midwifery. This is so medical and controlled. Hospital midwives do not spend so much time with their patients because of the shortage of staff.
In most of Africa, the majority of births occur at home under the care of a midwife just like centuries ago. The difference is these midwives are no called Traditional Birth Attendants (TBA). This derogatory term is given to my grandmother and many other women who work in rural villages and win the confidence of birthing women for their skills and understanding. With the current shortages of midwives in Africa, more attention should be on the need of the African woman.
Despite all the money spent in African on hospitals, the World Health Organization and various other organizations involve in birthing have not managed to alter this mind set. The main reason for this apparent impasse is that those in the west do not understand the African culture. Birth practices are implemented in Africa by people who do not understand the African culture at all. How on earth can a woman be expected to find her way to a hospital if there are no roads or transport. Nevermind the fact that she might be alone with no labour support or back up. Many of the clinics are far away and lack staff, equipment and drugs. If there are staff at the clinics, their numbers are normally insuficient to meet the needs or demand of the labouring woman.
Why should women subject themselves to the extra burden of a long journey, alone and in pain and at the end of the journey she might be placed in a tiny bed with tens of other women, away from family and friends. It is far better that women birth at home amongst family and friends in the care of a midwife who are able to lend support and give comfort during the long hours of labour. The question begs to ask, why not train women in the African villages as to what the inside of a hut looks like and not that of a hospital room. There is a very big learning curve to be addressed when it comes to birth in Africa.