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Bridget McGann Medical Anthropology M/W 5:30P Term Paper Monday, April 26, 2010

Maya Childbirth Traditions in a Medical Pluralist Society: An Ethnomedical Perpective

Childbirth occurs in all cultures. Although all humans share this biological process in common, birth, like death, is an event that comes with heavy with ritual and meaning unique to each culture. The Maya culture of north Central America has served as host for much of the development of the anthropology of birth as a viable subfield of medical anthropology. This discussion will draw on the two foundational participant-observation studies in this field, both done in the Yucatan region of Mexico: that of Brigitte Jordan in the 1970s as well as a sort of continuation of her work, between 1992 and 1994, conducted by Carolyn F. Sargent and Grace Bascope. Through their groundbreaking research, we have discovered how this low-tech, woman-centered (Davis-Floyd and Sargent, 2007:3), traditional birth model has changed remarkably little despite attempts by the government to introduce biomedical techniques and interventions.

This paper will describe the Maya childbirth tradition in the context of a contemporary medical pluralist society using an ethnomedical perspective. The ethnomedical

approach considers any given health system, including biomedicine, to be a product of its culture. It ethnographically describes and seeks to understand aspects of health such as healing practices, health-seeking and health maintenance behavior, how people understand and explain their health issues, the existence of multiple medical systems within a single society (known as medical pluralism) and the factors that influence choices made between them, and health-related beliefs and traditions (Brown and Barrett, 2007:1-9). Childbirth occurs in all cultures. Although all humans share this biological process in common, birth, like death, is an event that comes with heavy with ritual and meaning unique to each culture. Childbirth serves as a striking expression of a cultures most deeply held values. Strong feelings are held with regards to this matter. Within every culture lie specific ideas of what constitutes a correct or normal birth, and also ideas of expected behaviors of those in attendance. It is almost universally an exclusive event, with a strict set of rules regarding who is and is not allowed to be present. The Maya are no exception.

The term Maya refers to about 6 million descendants of a civilization indigenous to the Yucatan peninsula and present-day Guatamala that dominated the region from around the first century CE until the arrival of Spanish conquistadors. Having been exploited by the Spanish for their labor and land, most Maya now live in poverty in small villages, working mainly as sustenance farmers, craftspeople or produce traders. Women have considerable authority within the household and are also active in market trade. (Ember and Ember, 2007; Miller, 2009) Maya families traditionally live in matrifocal family compounds, with a large central house surrounded by small, one-room buildings. The traditional Maya dwelling is oval-shaped, with wattle-and-daub walls, a palm-thatched roof, and a pressed dirt floor, though the main house may be constructed in a more modern style, with stone walls and a corrugated metal roof. By day, the main house is the center of activity and where visitors are entertained. By night, it is where the entire family sleeps in hammocks hung from the rafters. The auxiliary buildings are usually built in the traditional style and serve as sort of multi-purpose spaces. They may serve as storage facilities, spill-over sleeping space or crafting spaces (Jordan 1993:22-23).

A married Maya couple typically lives with the husbands family until they have the means to build their own compound (Davis-Floyd and Sargent, 1997). A mother may deliver in any one of the buildings either within her own compound or, if it is her first child, her own mothers compound (Jordan 1993:24). She is surrounded by a midwife, her husband, and many female family and friends known as ayudantes (helpers). She usually labors in the same hammock that she sleeps in every night, dressed in a light gown to avoid the shame of immodesty. She labors in a familiar, highly supportive, primarily female environment. The traditional Maya birth attendant is referred to as a partera or a comadrona (the former being the term primarily used by Jordans research participants) (Jordan 1993). The partera is called upon rather early in labor, relative to the 4-1-1 rule followed by Americans.1 The role of the partera is quite similar to the role of a midwife in many cultures. She provides instructional and emotional support to the mother, receives the baby upon birth and cuts the umbilical cord, and provides prenatal and parturitious (during labor) massage, called sobada (Jordan, 1993).

The Partera begins a birth by spreading a cloth down underneath the mothers hammock and typically takes a position in front of the mother. Doors are shut and cracks are patch or stuffed up to protect the mother and baby from evil spirits of the bush (Jordan, 1993). The other women in the room will provide continuous emotional and physical support to the mother throughout labor. The father typically assumes the head helper role, supporting mothers upper body from a chair behind her (Jordan, 1993). The father is typically the only male in attendance. It is said that he should know how a woman suffers (Jordan, 1993). Until the birth of his first child, a young man knows nothing of the womens business of childbirth (Jordan, 1993:95). He takes his cues and instruction from the women surrounding him. Experience is held as the most valued determinant of authoritative knowledge of childbirth. The primiparous woman (a woman having her first baby) is therefore treated very differently from a woman who is giving birth to her fifth or sixth child. The primiparous woman is considered to be completely incompetent in her understanding of childbirth as well as knowing her own body, and is physically handled often and given a lot of instruction throughout labor. She is encouraged to hold her breath and push very early in labor by biomedical standards, and helpers may even forcibly cover her mouth with their hands or stuff a rag in her mouth to keep her from stopping to take another breath.

The multiparous woman (has had one or more babies before), in contrast, is in full control of her birth. She is considered experienced and knowledgeable as to how the birth should proceed. The atmosphere is relaxed and chatty, and when a contraction comes everyone assumes the roles that they have become accustomed to over the course of her previous births. When birth is imminent, the mother may stay in her hammock or move to sit on an overturned wooden chair that serves as a birthing stool. The women will start to talk to the mother in what they call birth talk. At the onset of a contraction, casual

conversation stops, writes Jordan. A rising chorus of helpers voices pours out in an insistent rhythmic stream of words whose intensity matches the strength and length of the contraction. They use few words, drawing from both Spanish ( jala, for example, meaning push) and Maya (koosh, or come on). The laboring woman is immersed in the intense sound and touch of her loved ones.

Parteras do not artificially rupture the amniotic membrane (a membrane containing clear fluid which encases the baby throughout gestation), and therefore many Maya babies are born in the caul,2 or nearly so. The partera will receive the baby and blow in its mouth to help it breathe. Once the cord has stopped pulsating (or possibly not until the placenta is delivered), she cuts it and passes the baby to the mother or grandmother while she waits for the placenta to be delivered. She might press down on the abdomen and pull on the cord to make the body release it. 3 The baby is washed and its navel stump cauterized with a needle, packed with gauze or cotton balls dipped in alcohol and wrapped. The baby is diapered in fresh cloth and swaddled to recreate the comfort of the womb and to ensure that its legs will grow straight (Jordan 1993:40). The newborn is not handled with any particular sense of delicacy at this time, and not much of an effort is made to support his or her head. It is believed that a newborn is not aware enough at this point to feel pain (Jordan, 1993). The partera will manually mold the newborns head as she sees fit (Sargent and Barscope, 1997:190). If it is a girl, the partera will pierce her ears with a needle and thread dipped in alcohol within minutes of birth (Jordan 1993:41). She then instructs the mother to give the baby two teaspoons of water and wait one hour to nurse. She will clean up and perhaps have a meal provided by the family, then leave when she is satisfied that the family is settled.

Mother and baby remain shut inside the home, protected from the spirits of the bush, for seven days. The partera returns a day or two after the birth for a checkup. The mother receives a warm bath infused with herbs or a little alcohol, and the baby is given a bath at this time as well, either with warm water or oil. The partera will also take this time to talk with the mother about how she is feeling, breastfeeding advice, and how to go about introducing solid foods (Jordan, 1993). On the twentieth day postpartum, the midwife will visit for one last sobada and to wrap the mothers pelvic area with a faja (girdle, sash). The mother is instructed to lie on a towel on the floor, and the partera and an assistant will pass the faja back and forth over and under the mothers pelvis, every so often placing a foot against her hip and pulling the cloth taut. The ends of the faja are then tied in a knot in front below the belly, forming a sometimes discernable faux penis, which, Jordan noted, the women would laughingly refer to as pollo (this word has the same double meaning as the English cock.) This practice, called amarrar, is believed to aid in reducing the mothers uterus and abdomen to their pre-pregnancy sizes, and formally concludes the childbirth process. The mothers head or breasts may also be wrapped for similar reasons (Jordan, 1993).

This twenty-day period corresponds with the twenty-day months of the infamous Maya calendar, the tzolkin, which culminate in a 260-day year. Jordan noted that, although no natural cycles, including terrestrial or celestial events, appear to correspond to this 260-day period, one human biological period does: the human gestational period, as counted from day of conception until birth (Jordan, 1993:44). 4 Besides the faja, a garment that plays a large role in the life of a Maya woman is the rebozo, the traditional Mexican all-purpose shawl. The rebozo is a long piece of woven wool or cotton about thirty inches wide. Depending on what a woman finds herself in need of at a given time, the rebozo may serve as a decorative garment or, because of its strength, a burden bearer (Sayles, 1955). During the birthing stage, the rebozo may be slung over a roof beam for the mother to pull herself up on during contractions (Jordan 1993:36). The mother also uses the rebozo as an infant carrier. Maya babies are

always held by someone except when they are asleep, at which point they may be placed in a hammock. They are picked up again immediately upon waking (Jordan, 1993:43). The mother or another caregiver will sling the rebozo over her shoulder and tie it one of a variety of ways, creating a pouch in which an infant may sit or lie down. This style of baby-wearing allows her to carry her baby close to her while leaving her hands free to do daily tasks and allowing her baby to discreetly breastfeed on demand (Sayles, 1955).

Because of its versatility, the rebozo has been adopted by many other cultures that do not already have their own parallel garment. In the United States, for example, the rebozo is used by doulas either prenatally or during labor as an aid to turn an occiput-posterior fetus (a baby which is lying head down and facing away from the mothers back, which is a position that makes it difficult for it to pass through the mothers pelvis) by slinging the rebozo underneath the mothers pelvis and lifting it up above her head. This allows gravity to pull the fetus head out of the pelvis so that it might reposition itself. In general, however, the rebozo is known for the intricate and colorful designs that are painstakingly woven into them. At a birth, the partera serves as master of ceremonies of sorts. Her arrival at the home signals the beginning of the birth process, and her final visit signals its end. But how did she get here? Who gave her this authority? A partera begins her career with an apprenticeship to an established partera or a shaman. However, it is family status and experience that most influences the authoritative power she is given by the community. Dona Lila, the more prominent of the two parteras who served the village that Sargent studied, came from a large, prominent family that consisted of most of the village elders. She was trained by her father-in-law, who was a respected shaman. The villagers described her as respected and courageous, and her family as trustworthy, discreet and reliable.

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The less prominent partera, Dona Flora, came from a rather small family and was really only called upon either when Dona Lila was unavailable or because of family ties with Dona Flora. Among the villagers, she was considered to be incompetent, her methods questionable, and even the circumstances under which she became a partera were considered a fluke. Among the Maya, authoritative power in matters of childbirth is bound up not in control of technology but in experience and family standing. The partera uses mostly traditional herbal remedies and techniques, such as prenatal therapeutic or diagnostic sobada and the application of olive oil to a crowning babys head to help it slip past the perineum (the flesh between the vaginal opening and the anus of the mother which is sometimes cut by Western obstetricians) easier (Sargent and Barscope, 1997:191). In recent years, however, many partera have acquired some biomedical skills, such as the administration of synthetic oxytocin (a hormone involved in causing contractions as well as other reproduction-related functions) to hasten the progression of labor. In the late 1970s, the Mexican Ministry of Health and the National Indian Institute (INI) collaborated to instruct traditional midwives in the area in biomedical obstetrics (Sesia, 1997:399; Jordan 1997:171). They were instructed in

standard biomedical procedures such as proper scrubbing in technique, insertion of intra-uterine devices (IUDs), sterilization of instruments and use of rubber gloves and facemasks. The parteras who attended these classes did not continue to use very many of these techniques once they returned to their practices.

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However, one skill that was retained by many was the use of a synthetic oxytocin injection to speed labor. While use of oxytocin may not seem at first to be congruent with what is traditionally a low-technology birthing style, it is in fact consistent with the Maya belief that although childbirth is not an illness as it is treated in the biomedical system, it is believed to be a dangerous time that is best over with as quickly as possible. Further, the oxytocin injection may also serve as a source of authoritative power for the partera. Maya childbirth is largely an egalitarian affair, with decisions primarily made not by the birth attendant as in biomedical childbirth, but by the group as a whole. The actual power held by the partera is accordingly less than would be expected from an American or western European midwife. In the absence of oxytocin, and before its introduction, techniques such as applying considerable pressure to the fundus (the large muscle that runs over the top of the uterus) while manually stretching the cervical os (the opening through which the baby passes from the uterus into the vagina) during a contraction would be used to speed the progression of labor (Sargent and Barscope, 2007:191. The parteras relevance is bound up in these special skills. However, as she ages and her physical ability to perform such tasks diminishes, her primary source of authority rests in the oxytocin injection, this realm of knowledge alien to those around her (Sargent and Barscope, 1997:191).

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While the vast majority of Maya deliver at home, serious complications that arise during the course of the pregnancy or labor may influence a move to a biomedical facility if there is one accessible. The village in which Sargent conducted her research was located about five kilometers down a dirt road from a clinic, which women rarely visited. Social Security doctors were appointed to visit the town weekly, though the visits were irregular. For the most part, the biomedical services they found useful were provided by the parteras who had attended the government courses. Though groundbreaking in their detail and observational treatment, the ethnographies of Jordan, Sargent and Barscope offered little insight as to the beliefs behind the practices described herein and the meanings that the Maya associate with this event. The

matter may warrant further investigation. Nevertheless, by all appearances the Maya appear to have found themselves in a situation where coexistence with biomedicine in a medically pluralist society works well for them culturally. 5 The intimate study and

preservation of childbirth traditions of indigenous peoples, especially a people as ancient as the Maya, may improve an invaluable asset in improving mother-infant care in our own system as well as globally. Therein lies the valuable purpose of

ethnography, participant-observation and the ethnomedical perspective.

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Notes
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The 4-1-1 rule is a memory tool taught in American biomedical birthing classes to that says it is time to go to the hospital when contractions are four minutes apart, lasting one minute each, for at least one hour. 2 in the caul or en caul (latin) refers to a baby born with the amniotic membrane still intact around the body. In many cultures this is rare and bears religious or supernatural significance, but none of the sources consulted mention any Mayan belief regarding this matter. 3 Sargent separately mentions that the Maya believe the delivery of the placenta to be an event of great cultural significance to the Maya, and that the partera only cuts the cord because no one else is willing to do it. She offers no explanation for these beliefs, however. 4 Jordan cites a 1975 manuscript by Frank Griswold which was, as of the 1993 publication of Birth in Four Cultures, housed at the Department of Anthropology at the University of California at Sacramento and therefore unobtainable by the author of this paper. See bibliography. 5 Whether or not the Mayan birth model can be considered biomedically successful has been investigated by Paola M. Sesia of the University of Arizona, Tuscon, but that is beyond the scope of this paper.

WorksCited Brown, Peter and Ron Barrett. Understanding and Applying Medical Anthropology . Boston:

McGraw Hill, 2010. Davis-Floyd, Robbie E. and Carolyn F. Sargent. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Ed. Robbie Davis-Floyd and Carolyn Sargent. Berkeley: University of California Press, 1997. Davis-Floyd, Robbie E. and Carolyn F. Sargent. Introduction: The Anthropology of Birth. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives . Ed. Robbie Davis-Floyd and Carolyn Sargent. Berkeley: University of California Press, 1997. 1-51. Ember, Carol, Melvin Ember, and Peter Peregrine, Physical Anthropology and Archaeology, 2nd edition. Prentice Hall, 2007. Griswold, Frank. An Hypothesis for the Origin of the Mesoamerican 260 Day Calendar. Manuscript. Department of Anthropology, California State University at Sacramento, 1975. Jordan, Brigitte; Revised and expanded by Robbie Davis-Floyd. Birth in Four Cultures. Waveland Press, Inc., 1993. Kitzinger, Sheila. Authoritative Touch in Childbirth: A Cross-Cultural Approach. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives . Ed. Robbie Davis-Floyd and Carolyn Sargent. Berkeley: University of California Press, 1997. 209-232. Miller, Barbara. Cultural Anthropology in a Globalizing World , 2nd Edition. Pearson, 2010. Sargent, Carolyn F. and Grace Barscope. Ways of Knowing About Birth in Three Cultures. Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives . Ed. Robbie Davis-Floyd and Carolyn Sargent. Berkeley: University of California Press, 1997. 183-208. Sesia, Paola M. "'Women come here on their own when they need to': Prenatal Care, Authoritative Knowledge, and Maternal Health in Oaxaca" Childbirth and Authoritative Knowledge: Cross-Cultural Perspectives. Ed. Robbie Davis-Floyd and Carolyn Sargent. Berkeley: University of California Press, 1997. 397420. Singer, Merrill and Hans Baer. Introducing Medical Anthropology: A Discipline in Action . AltaMira Press, 2007. Sayles, E.B. Three Mexican Crafts American Anthropologist, New Series, Vol. 57, No. 5 Blackwell Publishing on behalf of the American Anthropological Association, October, 1955. 953973.