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Politics and Cultures of Midwifery: Epistemologies, Expertise, and Praxes

Panel XII-6, 2023 Annual Meeting

On Sunday, November 5 at 11:00 am

Panel Description
Decolonial, feminist, and anti-imperialist approaches to birth and birth control remain marginal to studies of culture, politics and institutions. Demographic anxieties, which are often racialized and gender-conservative, shape much of the public health scholarship and policy debates on these questions, driven by Western government, “non-governmental,” and corporate funding, as well as national and geopolitical priorities. This panel uses transnational decolonial feminist approaches to take seriously the work, politics, and cultures of midwifery in a cluster of geographic sites (Mexico, Palestine, Tunisia) and representations of midwives and their work in Arabic medical and literary texts. The panelists use ethnographic, archival, and literary methods and sources. We consider the tensions and histories of this field of expertise using a historical lens as well as the experiences and analyses of midwives, whose centrality to birth and birth control has been effaced by medicalized, privatized, state-controlled, and usually male-dominated structures and institutions. We also reinsert questions of sex, sexuality, and desire into the analysis as these are typically extracted as somehow irrelevant to pregnancy, birth, healthcare, birth control, and postpartum life. In addition to considering literary and other textual representations of midwives as sources of power threatening to dominant cultural systems, the papers are thematically connected by their interest in the medical, psychological, and institutional knowledge accumulated by midwives in their praxes; their negotiations with dominant cultures, families (including their own), medical systems, physicians and associations, and governments; and their gains in terms of cultural, social, material, and affective “capital” over time, despite allopathic and profit-driven systems designed to negate their expertise and efface them as competition.
  • Rebecca Saab Saade
    In this essay we explore the representation of knowledge surrounding childbirth and childcare in the late nineteenth century, using the journal al Muktataf as a case study. To do so, we examine three articles in particular written by different authors and with different angles. It is fairly easy to follow the broad development of science and medicine in the Arabic speaking region. Knowing how this process took place is another question. Thus, midwives were pushed out of the process of childbirth in the late nineteenth century to the early twentieth just as traditional knowledge and practice were being substituted with “modern” western ones. In this essay we aim to explore how that process was taking place by studying the discourse presented by one scientific journal of the time. In the second issue of the first year (1876), Amine Abi Khater, a medical doctor, wrote a lengthy article titled الإعتناء بصحة الأطفال, on the subject of childcare. The author opposes the knowledge of the new class of doctors to that of women and midwives. In the issue of July 1881 (year 6), the editors published an article titled الإنكليز في عيون أهالي الصين or the English as seen by the people of China. Here we explore how the knowledge of the Chinese regarding childbirth were represented and opposed to western knowledge and how the editors represented the two and how they positioned themselves between them. Finally, we compare these articles, written by men, to those written by women. Using the first article written by Yaqut Sarruf we analyze how a woman’s voice differs from that of men. In conclusion, acknowledging the representational and empirical limitations of any specific archive we attempt to examine what these articles can tell us about knowledge of childbirth at the time.
  • Dr. Camila Pastor de Maria y Campos
    I explore representations of birth, midwives and material and political contexts of their expertise in contemporary Arabic fiction and Muslim convert narratives in Mexico. I read these through the increasingly sophisticated histories and ethnographies of colonial medicine and reproductive health in the region and my own ethnography of the new Muslim midwifery in Mexico. Muslim midwives in Mexico invoke the Quranic narrative of the birth of the prophet Jesus as paradigmatic of birth and their own role. Maryam labored and birthed alone, aided by the miraculous date palm which fed and sustained her. Birth is naturalized and sacralized as an instinctive act that a laboring woman achieves on her own, with the help of God. As midwives, they are companions and facilitators to this transcendental junction; thus they claim the midwife’s “cosmological-existential dimension” (Giladi 2015) at the heart of Ibn Khaldun’s Muqadimat. As pertains to postpartum, the core shift in convert miwives' experience reflects their sexualization of birth and support of birthing mothers' reclaiming of sexuality and sexual pleasure. In the fiction of Moroccan Tahar Ben Jelloun (L’Enfant de Sable, 1985), Algerian Nora Aceval (Contes du Djebel Amour, 2006), Omani Joha Al-Haarti (Sayyidat al Qamar, 2010), Saudi Raja Alem (Khatem, 2011), and the stage production of Palestinian Bashar Murkus (Milk, 2022), midwives presence or absence at birth are crucial to emplotment. In L’Enfant de Sable the midwife, described as both greedy and willing to twist the will of God, becomes an accomplice to patriarchal desire for a male heir. In Nora Aceval’s collection of Algerian fairytales, the substitution of a witch as birth attendant allows a Sultan’s jealous senior wives to make the desired male heir disappear at birth, and his wronged mother to be evicted from the harem. In Al-Haarti’s Saayidat, birth is a marker of social status, supported to a burdensome degree for the shaikh’s daughters, and as a lone, efficient procedure by slave women overtaken by labour at their tasks. In Alem’s Khatem, the absence of a midwife causes extreme suffering during labor, and the child’s uneasy gender assignation. In Murkus’ Milk, the material of a new birth and life is transfigured by death. Wasted breastmilk, that there is no one to drink, embodies the loss of one’s own, or mulk, in mothers’ unremitting grief for their dead children. Even the powerful experience of a new birth, on stage, cannot efface such loss.
  • This paper analyzes interviews with Palestinian healthcare providers of multiple generations in July 2016 and June 2017: three ob-gyns (2 men), seven women nurse-midwives, and two traditional women midwives who worked with public and private medical institutions in historic Palestine, often across institutions. I follow three lines of tension among the nurse-midwives, between some of them and traditional midwives, and in relation to physicians and medical institutions in contexts that have over time medicalized (and masculinized) maternal and childbirth healthcare to the point where “most women do not feel safe delivering without the hospital complex behind them.” The first relates to the autonomous status of midwifery, which through the mid-1960s dominated Palestinian life. Both autonomy and preponderance have largely disappeared as a result of medico-legal and policy changes led by physicians, especially ob-gyns. Nurse-midwives explained that “obstetrics makes you a rich man.” But they were divided on whether they should have more independence from physicians, with some fighting for it, including the ability to suture torn vaginal tissue after birth. One called the Ministry of Health under the Palestinian Authority a “Ministry of Physicians” that set the rules in their favor on basis that “physicians know everything.” Others lacked confidence in that level of authority or feared a newly dominant litigious sensibility among Palestinians that if something were to go wrong meant they had to carry the consequences. The second line of inquiry relates to the medicalization of pregnancy and childbirth care in comparison to the approaches of traditional midwives. Here older nurse-midwives were more likely to integrate the holistic methods of traditional midwives, and like traditional midwives, carried an enormous amount of knowledge about women’s bodies gained through experience, examination and touch interventions for infertility, miscarriage, abortion, pregnancy, and childbirth. These practitioners were more likely to value autonomous midwives as “keepers of the secrets of wombs and paternity,” in a relationship of shared power with birthing women. An additional line of difference emerged from four providers who were highly cognizant of the psychic and sexual dimensions of pregnancy and childbirth, including the ways in which lack of sexual and bodily knowledge among young women, fear, and sexual trauma can shape pregnancy and childbirth but are excluded from allopathic medical training and institutional practices, which are oriented toward the normative family, delimited international health metrics of “development” for maternity and infancy, and legal constraints.
  • Dr. Livia Wick
    The paper is based on a re-reading of ethnographic fieldwork that includes many interviews I conducted with Palestinian midwives between 2002 and 2004 as well as longitudinal research with them over fifteen years of visits. It analyzes their struggles in the workplace, community, and family, as well as with the Israeli military and Palestinian Authority bureaucracy. I find that the experience of work, work relationships, and the stakes of the work change over the long term as midwives gain experience, save money and accumulate cultural capital. Midwives come from poor rural and refugee backgrounds, move to urban centers and develop new relationships with colleagues and new relationships to their villages and camps of origin. While midwives’ salaries are modest, they always have work because there is a market and need for it in hospitals. Thus, over the long term, midwives ascend through class structures of the occupied territories. I observe this ascension as some of them move to neighborhoods outside the refugee camp, buy property in their villages and send their children to private universities. Living in multiple worlds across classed communities is also audible in the language they develop and the genres of speech they use and those they avoid. Indeed, midwives were well versed in the genre of oral histories and pushed me to collect them. These were narratives with a realist narrative arc, that began with a life of poverty, went through a middle of struggle and ended with an uncertain future. They punctuated their narratives with dates important to the struggle for Palestinian liberation and situated their lives in clearly demarcated spaces. While the narratives flowed and worked, at specific moments, they were disjunctive. These moments of disjuncture reflect their attempt to narrate moments of pain due to abusive divorcees or unsupportive families. Thus, the paper will analyze the forms of capital midwives gained over the years, the ways they narrated their lives and the ways their work over the long term changed their sense of self.
  • In 1962, the Tunisian government introduced the first family planning program in Africa, a program that expanded nationally by the mid-1960s. The legalization of abortion soon followed – first in a limited way in 1965 and then, in 1973, the Penal Code was amended such that abortion became legal, without restriction as to reason, marital status, or age, throughout the first trimester of pregnancy. From its inception, midwives were fully integrated into the national family planning program. Initially, the Tunisian government recruited and trained traditional birth attendants to both support and care for women’s primary reproductive health needs. As professional midwifery training programs expanded throughout the country, the scope of practice of these highly qualified health service providers evolved to include the insertion and removal of intrauterine devices and the provision of first trimester abortion care. Midwives also actively participated in the clinical trials dedicated to both emergency contraception and medication abortion and thus championed the incorporation of new and emerging reproductive technologies into the public health sector. Drawing from primary fieldwork conducted over the last 20 years, this paper chronicles the journey of midwives in the national family planning program in Tunisia. I argue that the recognition and incorporation of traditional birth attendants into the health system in the wake of independence set the stage for a more team-oriented approach to the provision of reproductive health services that resulted in task-shifting in later phases of the program. Further, women’s leadership in the development of the national family planning program and the liberalization of the abortion law proved critical in recognizing the importance of women health care providers, and midwives in particular, in addressing comprehensive reproductive health needs at the individual and community level. Finally, the inclusion of midwives in interventional studies not only allowed the national family planning program to evolve and grow but established some of the best evidence in the region that midwives can provide contraception and abortion care that is at least as good, if not better, than the care provided by physicians. Tunisia’s experience offers important lessons for how midwives could be integrated in ongoing efforts throughout the region to increase access to both contraceptive and safe abortion services.