In my practice, the C-section rate is five percent. In fifteen years, I have never done an episiotomy. My rough estimate would be that, unattended, these communities have a maternal death once in every ten years or so, maybe less. For women who have so many babies well into later age and have the worst varicose veins you have ever seen, they have almost no complications."

*"Sarah" is a pseudonym because the practice of direct-entry midwifery is illegal in New York State.



In Tjirrkarli, in the Ngaanyatjarra Lands of western Australia, Ngaanyatjarra women now often leave their remote communities many weeks and sometimes months before their babies are due, to give birth in regional hospitals. This has also become the case for most other Aboriginal women living in remote parts of Australia. However, a strong and unique birthing culture continues to survive among the Ngaanyatjarra, passed through a kinship network of sisters and daughters, grandmothers and aunts, even as aboriginal women face increasing encroachment from homogenous Western medical influences.

The Ngaanyatjarra prepare for birth with the understanding that it is both a natural and sacred part of life. Girls are present and involved when other women in their family and social circle give birth, and pregnant and postpartum women are given an elevated status within their extended family and larger community networks. Among the Ngaanyatjarra, the care of a pregnant or birthing mother is almost exclusively the domain of other women.

Although spouses play a limited role, the pregnant woman seeks out other women for medical advice and care, as well as for friendship. These supportive women see themselves as serving several purposes for the expectant mother: to make sacred the process of birthing, to build the confidence of the pregnant woman, and to ritually protect both the woman and her unborn child.

Spiritual ceremonies recognize that pregnancy is a particularly vulnerable time for the woman and her baby at both a psychic and emotional level. The father often has a role in these rites to ensure that his loved ones are kept free of any negative influences. As a rule, pregnancy is considered a time when a woman is expected to surround herself with only positive sights and sounds, and often great care is taken to avoid anything that may cause tension or distress. Moments of heightened intensity such as altercations of any sort, being with other women during their own childbirth, or sighting the body of a deceased loved one are generally considered taboo during pregnancy. It is also considered unthinkable to speak to pregnant women about birth as something which is traumatic, physically painful, unpredictable, or unbearable. Birth is represented as deeply profound, mysterious, and culturally and spiritually affirming.

An aboriginal woman knows long before she gives birth who will be present when she delivers and what each person's role will be. In most cases, she will have had a longstanding relationship with all of her birth attendants, including the one who acts as her midwife. The guiding rule is for the birthing woman to be attended only by those who will make her feel totally at ease and loved throughout the birth process. Anyone or anything which may distract or distress a birthing woman is consciously kept at a distance. A minimum of conflict is said to contribute to a quick and easy delivery.

Sometimes, the husband will also be present at birth to physically support his partner. More often, however, his role is to perform specific rites some distance away from the birthplace. Those women who are in attendance at the birth may also perform particular rites, such as chanting, singing, dancing, or drumming.

The Ngaanyatjarra consider the burial or preservation of the placenta of the utmost importance. They also place great emphasis on seeing that the umbilical cord is cut at what they believe to be just the right place. These two birth practices are believed to be fundamental for the social, psychological, and spiritual future of the child and its family.

Following the birth, new mothers and their babies are thought to be in need of extra-sensitive treatment for some time. Various rituals are undertaken and prohibitions are observed in the weeks following the baby's arrival to ensure that the mother regains her strength and develops a good supply of milk. The baby will also have rituals performed to protect it from evil spirits, as well as to ground and guide it throughout its life.

Written with the assistance from birth researcher Linda Rawlings. Much of the information herein was adapted from Rawlings' presentation, "In the Spirit of Birth."



As with other elements of their personal well-being, many pregnant Chinese women look to the Taoist theory of Yin and Yang with regard to their childbearing. Both forces must be in balance in order to have a comfortable pregnancy and a healthy baby. Pregnancy is considered a joyous time because children are thought to be a blessing and a way of continuing a family's lineage, an important Chinese value.

When a woman gives birth, her body is thought to be depleted of the "hot" element: blood, as well as her inner energy, called "chi." This places her in a "cold" state for around forty days followiing childbirth, a period assumed to be needed for the uterus to heal. This period is commonly known as "the confinement period" and during this time, the woman is expected to observe specific restrictions in her diet and activities. She is advised to rest as much as possible, and to wear socks and sweaters in order to warm her body. Some families even keep all the windows in their home closed during this time to keep heat from escaping. Additionally, new mothers try to avoid having any air or wind blowing in their immediate direction. The new mother rarely, if ever, leaves home during the confinement period.

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