In order to create a world where we effectively decolonize our healthcare systems and practices, we must look at how colonization affects our practices and cultures today. Decolonization requires us to acknowledge and dismantle hidden institutional, historical, and cultural forces that perpetuate disjointed systems of power. This assessment of our practices, and looking into the grassroots of this issue, will allow us to paint a better future for those in our care. This is particularly important when we look at women’s healthcare, specifically birth. For hundreds of years, women have birthed babies without medical interventions despite the risks. While medicine has its place in preventing morbidities and mortalities - specifically with respect to preeclampsia, fetal growth restriction, multiple gestation, and other high risk pregnancies - unnecessary interventions can have a negative impact on not only the birthing experience, but on the wellbeing of the mother and the newborn/fetus as well.

Modern day assessments of birthing positions illustrate how Western ideologies have influenced our practices. Much of the obstetrical ideas we use today were put forth by the French about 300 years ago as they were seen as the leaders in obstetrical care. Looking back into ancient Egyptian depictions, women are seen in the kneeling position surrounded by 5 attendants, one of whom assisted in delivering the baby. Up until around 1550, midwives delivered babies, and these midwives were all women. It was not until 1517-1590, that surgical- obstetricians (who were typically male) began to compete with midwives for obstetric cases. At first, they were poorly trained, but as time progressed, they developed the skills to help women, especially in cases of complicated births. During this time, the provider the woman chose was linked to how she viewed pregnancy (much like today). If pregnancy was viewed as a normal, natural event, then the surgeons’ servicers were not required. However, if pregnancy was seen as an illness, the presence of these men seemed more appropriate (Dundes, 1987). This new addition of providers and views on pregnancy, eventually created a shift to more medicalized births.

The overmedicalization of birth can and has, for many women, created fear around this empowering event in their lives. Overmedicalization can also force women into believing that they are unable to birth their babies, as women have done for centuries. This results in the development of poor opinions about traditional practices. Nowadays, many believe the best place for delivery is within the walls of a hospital, with trained professionals. While this may be true in some cases, it is not true for all, particularly those who do not have access to these professionals and rely on traditional birth assistance. If we are to decolonize birth, traditional birth assistance must have a role, especially in areas where resources are scarce. Just because someone does not have access to care, does not mean they are unable to safely deliver their baby. Women should have the option to choose, and not be forced into one setting or another. To aid in providing this choice, we must implement health education that increases community awareness about the importance of health services. This type of public health strategy must involve traditional birth attendants, particularly in remote areas where these types of services are highly utilized (Titaley et al., 2010).

When looking at people’s needs during birth, we must honor and respect their cultural values and traditional birthing practices. This is broadly defined as “all beliefs, behaviors and rituals demonstrated during antenatal, labor and birth, and postnatal periods which are socially constructed by the perceptions and practices of the culture” (Naser et al., 2012). For many cultures, specifically indigenous cultures, birth is viewed as a ceremony that introduces new life into the world, acknowledging the passing from the spiritual world into the physical (Hayward & Cidro, 2021). This is incredibly important when we are supporting and assisting women during their labor and birth.

It is important to also acknowledge how racism affects experiences and outcomes for women worldwide, with lower income countries carrying the burden of health inequalities. It is well understood that the greater the extent of marginalization, the greater the negative health impacts. Due to this, we must use an intersectional lens to explore the outcomes for people belonging to multiple marginalized groups. This is especially important during pregnancy, when women are the most vulnerable. Patriarchal systems worldwide dictate the roles, the power and the freedom women have. In order to decolonize and reorient our systems, we must change who determines our social and cultural priorities and values to allow us to pave a pathway to a more sustainable and equitable future (Matheson et al., 2021).

References:

Naser E, Mackey S, Arthur D, et al. An exploratory study of traditional birthing practices of Chinese, Malay and Indian women in Singapore. Midwifery 2012; 28:e865–e871.

Hayward A & Cidro J. Indigenous Birth as Ceremony and a Human Right. Health and Human Rights 2021; 23:213–224.

Titaley CR, Hunter CL, Dibley MJ, & Heywood P. Why do some women still prefer traditional birth attendants and home delivery?: A qualitative study on delivery care services in West Java Province, Indonesia. BMC Pregnancy and Childbirth 2010; 10:43.

Dundes L. The evolution of maternal birthing position. American Journal of Public Health 1987; 77: 636–641.

Matheson A, Kidd J, & Came H. Women, Patriarchy and Health Inequalities: The Urgent Need to Reorient Our Systems. International Journal of Environmental Research and Public Health 2021; 18:4472.