By Caroline Flint

The culture of childbirth is being ignored, says Caroline Flint. She calls for a greater awareness of cultural differences in the experience of childbirth and argues that this need not impinge on the safety of the baby

We care about our culture. Each nation tries to preserve its cultural heritage. Go to Wales and you will see signs in the Welsh language and hear people speaking in Welsh. Go to Ireland and you will hear the Erse being spoken. Go to Scotland and you can hear Gaelic being spoken and a cultural heritage being preserved.

Our cultural heritage is important and we realize this and preserve it. It gives us a sense of our own history. It gives us a sense of identity. It is a necessary part of our culture. And yet, what seems to me to be the most important part of culture, the tap root of our society and how that society functions, is missing.

The way we are born and the way we give birth seem to have been neglected as part of our culture. While we have been carefully cherishing music, art, paintings, endangered species of animals and birds, ancient manuscripts and even old vacuum cleaners, the cultural heritage of how we give birth and how we are born has been totally ignored.

Not only do we alienate ourselves from our own cultural heritage when we apply no sensitivity to the way in which we give birth, but also many women who come into our hospitals to give birth come from a different cultural background from the indigenous population. All too often we give no respect to how each women would normally give birth, how she would normally move, what she would normally eat, who she would normally have with her, what she learned at her mother's knee.

Birth is very much part of our culture. I recently watched some colourful Bulgarian dancing. With it, there was a photographic exhibition, which included a photo showing about 30 babies in cribs attended by women in nurses' uniforms. The caption underneath proudly stated, `All mothers in Bulgaria are delivered in modern, well equipped clinics.' There babies, many of whom seemed to be crying miserably, were separated from their mothers. They were well fed, clean, and in modern cribs, but still separated from the source of their comfort.

I was reminded of an article about traditional birth attendants in India, which stated that the traditional birth attendants used dirty cloths for the labouring woman to sit on and used an unsterilized blade to cut the baby's cord. Having criticised these two unsavoury practices, the author concluded that all women should be delivered in hospital.

But does this necessarily mean that all births should automatically take place in hospital?

If all that is needed to ensure a safer delivery in the case of these particular traditional midwives is for them to wash the birth cloths and sterilise the blade, surely less upheaval would be caused by educating them in these two matters? This would seem to be preferable to uprooting the labouring woman and transferring her and her family -because when I was in India it appeared to me that most of the family went to hospital with the patient - to a hospital which could be miles away, and where she would be confronted with an American delivery bed complete with lithotomy poles. This is frightening enough for a western woman. But for the modest Indian woman, who may well be illiterate and speak in a different dialect to her care givers, and who is used to squatting to eat, to wash clothes, to wash dishes, to cook, to chat, to prepare food - what a humiliation it must be for her to lie strapped down, with her genitalia exposed to the world!

The thought is unbearable. So many of the women told me horror stories about the hospitals, and yet many of the trained nurse/ midwives told me horror stories about the traditional birth attendants. I was conscious of seeing a culture being destroyed, and I realized I was only seeing a repeat of what has happened here in Britain over the past 50 years, and indeed is still happening.

Here, very few women give birth in their homes. Very few children can say, as my son used to say as he ushered visitors into our house, `This is the bed I was born on.' Nor, as my daughter once did with a new boyfriend, `We'll go on a tour of the houses my brothers and I were born in and I'll point out the rooms we were born in.' Birth is very much a part of our culture. By alienating women from it, we are doing something which will affect our whole culture.

Some would say that we are doing it for the safety of the baby, but this is not necessarily true. As MacVicar said in 19811, more women having babies in this decade come into an obstetric low risk category than ever before in our history. We need to remember that those of us who interfere with something so basic to our roots as childbirth need to take care when we transplant the plant wholesale. Plants, like cultures, are delicate and need to be treated with respect.

1. Bardon, D. Speaking at the 25th birthday conference of the Association for Improvement in the Maternity Service. November 29, 1985. 2. MacVicar,1. (1981). `Changing birth patterns during a period of declining births.' Maternal and Child Health; 6: 7, pp. 280-284.

March 18, 1987