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The World Health Organization is currently promoting a policy of replacing traditional or lay midwives in countries around the world. As part of an effort to record the knowledge of local midwives before it is lost, Midwives and Mothers explores birth, illness, death, and survival on a Guatemalan sugar and coffee plantation, or finca, through the lives of two local midwives, Doña Maria and her daughter Doña Siriaca, and the women they have served over a forty-year period.By comparing the practices and beliefs of the mother and daughter, Sheila Cosminsky shows the dynamics of the medicalization process and the contestation between the midwives and biomedical personnel, as the latter try to impose their system as the authoritative one. She discusses how the midwives syncretize, integrate, or reject elements from Mayan, Spanish, and biomedical systems. The midwives’ story becomes a lens for understanding the impact of medicalization on people’s lives and the ways in which women’s bodies have become contested terrain between traditional and contemporary medical practices. Cosminsky also makes recommendations for how ethno-obstetric and biomedical systems may be accommodated, articulated, or integrated. Finally, she places the changes in the birthing system in the larger context of changes in the plantation system, including the elimination of coffee growing, which has made women, traditionally the primary harvesters of coffee beans, more economically dependent on men.

Recent anthropological scholarship on “new midwifery\" centers on how professional midwives in various countries are helping women reconnect with “nature,\" teaching them to trust in their bodies, respecting women’s “choices,\" and fighting for women’s right to birth as naturally as possible. In No Alternative, Rosalynn A. Vega uses ethnographic accounts of natural birth practices in Mexico to complicate these narratives about new midwifery and illuminate larger questions of female empowerment, citizenship, and the commodification of indigenous culture, by showing how alternative birth actually reinscribes traditional racial and gender hierarchies. Vega contrasts the vastly different birthing experiences of upper-class and indigenous Mexican women. Upper-class women often travel to birthing centers to be delivered by professional midwives whose methods are adopted from and represented as indigenous culture, while indigenous women from those same cultures are often forced by lack of resources to use government hospitals regardless of their preferred birthing method. Vega demonstrates that women’s empowerment, having a “choice,\" is a privilege of those capable of paying for private medical services—albeit a dubious privilege, as it puts the burden of correctly producing future members of society on women’s shoulders. Vega’s research thus also reveals the limits of citizenship in a neoliberal world, as indigeneity becomes an object of consumption within a transnational racialized economy.

With the increasing demand for midwives, activists are lobbying to loosen restrictions that deny legal access to homebirth options. InPushing for Midwives, Christa Craven presents a nuanced history of women's reproductive rights activism in the U.S. She also provides an examination of contemporary organizing strategies for reproductive rights in an era increasingly driven by \"consumer rights.\" An historical and ethnographic case study of grassroots organizing,Pushing for Midwivesis an in-depth look at the strategies, successes, and challenges facing midwifery activists in Virginia. Craven examines how decades-old race and class prejudices against midwives continue to impact opposition to-as well as divisions within-women's contemporary legislative efforts for midwives. By placing the midwifery struggle within a broader reproductive rights context,Pushing for Midwivesencourages activists to reconsider how certain political strategies have the potential to divide women. This reflection is crucial in the wake of neoliberal political-economic shifts that have prioritized the rights of consumers over those of citizens-particularly if activists hope to maintain their commitment to expanding reproductive rights for all women.

This groundbreaking book takes us around the world in search of birth models that work in order to improve the standard of care for mothers and families everywhere. The contributors describe examples of maternity services from both developing countries and wealthy industrialized societies that apply the latest scientific evidence to support and facilitate normal physiological birth; deal appropriately with complications; and generate excellent birth outcomes—including psychological satisfaction for the mother. The book concludes with a description of the ideology that underlies all these working models—known internationally as the midwifery model of care.

Background Midwifery plays a vital role in the quality of care as well as rapid and sustained reductions in maternal and newborn mortality. Like most other sub-Saharan African countries, the Democratic Republic of Congo experiences shortages and inequitable distribution of health workers, particularly in rural areas and fragile settings. The aim of this study was to identify strategies that can help to attract, support and retain midwives in the fragile and rural Ituri province. Methods A qualitative participatory research design, through a workshop methodology, was used in this study. Participatory workshops were held in Bunia, Aru and Adja health districts in Ituri Province with provincial, district and facility managers, midwives and nurses, and non-governmental organisation, church medical coordination and nursing school representatives. In these workshops, data on the availability and distribution of midwives as well as their experiences in providing midwifery services were presented and discussed, followed by the development of strategies to attract, retain and support midwives. The workshops were digitally recorded, transcribed and thematically analysed using NVivo 12. Results The study revealed that participants acknowledged that most of the policies in relation to rural attraction and retention of health workers were not implemented, whilst a few have been partially put in place. Key strategies embedded in the realities of the rural fragile Ituri province were proposed, including organising midwifery training in nursing schools located in rural areas; recruiting students from rural areas; encouraging communities to use health services and thus generate more income; lobbying non-governmental organisations and churches to support the improvement of midwives’ living and working conditions; and integrating traditional birth attendants in health facilities. Contextual solutions were proposed to overcome challenges. Conclusion Midwives are key skilled birth attendants managing maternal and newborn healthcare in rural areas. Ensuring their availability through effective attraction and retention strategies is essential in fragile and rural settings. This participatory approach through a workshop methodology that engages different stakeholders and builds on available data, can promote learning health systems and develop pragmatic strategies for the attraction and retention of health workers in fragile remote and rural settings.

Background Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women’s and Children’s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. Methods We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n  = 29) and traditional birth attendants (FGDs = 4; n  = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Results Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman‘s body and uterus. Further women are advised to conceive soon so that they get rid of infections. Conclusion Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

Women have long searched for a pleasing birth-a birth with a minimum of fear and pain, in the company of supportive family, friends, and caregivers, a birth that ends with a healthy mother and baby gazing into each other's eyes. For women in the Netherlands, such a birth is defined as one at home under the care of a midwife. In a country known for its liberal approach to drugs, prostitution, and euthanasia, government support for midwife-attended home birth is perhaps its most radical policy: every other modern nation regards birth as too risky to occur outside a hospital setting. In exploring the historical, social, and cultural customs responsible for the Dutch way of birth, Raymond De Vries opens a new page in the analysis of health care and explains why maternal care reform has proven so difficult in the U.S. He carefully documents the way culture shapes the organization of health care, showing how the unique maternity care system of the Netherlands is the result of Dutch ideas about home, the family, women, the body and pain, thriftiness, heroes, and solidarity.A Pleasing Birthbreaks new ground and closes gaps in our knowledge of the social and cultural foundations of health care. Offering a view into the Dutch notion of maternity care, De Vries also offers a chance of imagining how Dutch practices can reform health care in the U.S. not just for mothers and babies, but for all Americans.

The authors - social scientists and midwifery practitioners - reflect on regional differences in the emerging profession, providing a systematic account of its historical, local, and international roots, its evolving regulatory status, and the degree to which it has been integrated into several mainstream provincial health care systems. They also examine the nature of midwifery training, accessibility, and effectiveness across diverse ethnic and socio-economic groups, highlighting the key issues facing the profession before, during, and in the immediate post-integration era in each province.

AimThe rate of home births compared with health facility deliveries has severe implications for maternal and child health outcomes. In this paper, we explored the factors that influence home births in rural communities in the Krachi Nchumuru District of the Oti Region, Ghana.Subjects and MethodsThe paper used qualitative research methods involving in-depth interviews with fifteen women who gave birth at home and traditional birth attendants (TBA). Data were manually analysed using a thematic approach and the results presented in quotes.ResultsThe findings show that costs associated with health facility delivery, sudden onset of labour period, the absence of health facility and personnel, unavailability of transportation, support and care services of the TBA and the opportunity for spiritual assistance and intervention were the key drivers of home delivery among women in the district. The study also shows home births have some negative effects on maternal and child health during and after labour such as malaria, fever, bleeding after circumcision and a rise in body temperature.ConclusionSeveral contextual factors encourage home births among women in the Krachi Nchumuru District, Ghana. There is, therefore, the need to increase health facilities and personnel to provide skilled delivery care and improve the transportation infrastructure in the district.

The access to quality maternal health information amongst pregnant women plays an important role in determining woman's health behaviour during pregnancy. Yet, access to maternal health information remains a major challenge in Tanzanian rural communities especially for pregnant women leading to low utilisation of skilled maternal health services. The study aimed at examining the accessibility of maternal health information amongst pregnant women in rural Tanzania. A qualitative phenomenological study involving 25 pregnant women, 5 skilled healthcare providers (SHPs) and 5 traditional birth attendants (TBAs) was carried out in Chamwino District, Dodoma Region, Tanzania for a period of 6 months. Data were analysed thematically using the six-stage guide to thematic data analysis with NVivo Software. The acute shortage of healthcare personnel and traditional beliefs influenced pregnant women's access to quality maternal health information. The majority of women used mothers-in-law and TBAs as their primary source of maternal health information rather than skilled healthcare providers. Despite the acute shortage, healthcare providers need to play a leading role in providing maternal health information amongst the rural populations. Furthermore, skilled health providers need to work in collaboration with the TBAs to increase access to maternal health information and build a well-informed healthy society.