Humanising childbirth in South Africa : the role of indigenous midwives in countering obstetric violence

Abstract

Obstetric violence has increasingly become visible following research, advocacy, and activism by researchers, feminists, birth advocates, and scholars worldwide. This visibility is a result of the courage of women who have begun to speak openly about their childbirth experiences. Much of what has been written is framed within biomedical, feminist, public health, and sociological perspectives. Indigenous midwives are rarely mentioned in the literature on obstetric violence. This dissertation is an explorative and descriptive qualitative design using thematic analytical framework to explore lessons we can learn from Indigenous midwives to counter obstetric violence in South Africa. Adopting the Indigenous research methodology and Indigenous feminist theory, I undertook semi-structured in-depth individual interviews with 28 rural women sampled into three groups: 1) 10 women who gave birth in a healthcare facility assisted by biomedical healthcare practitioners, 2) 10 women who gave birth at home assisted by Indigenous midwives, and 3) eight Indigenous midwives who attend to women in their communities. I undertook the interviews using five languages i.e., Siswati, Xitsonga, Setswana, Sepedi and Sepulana. These are languages spoken across three provinces (Mpumalanga, Limpopo, and Northern Cape) in which the research was undertaken. Interviews were transcribed and translated into English. The study revealed that women who gave birth in healthcare facilities experienced dehumanised care in the form of abandonment and neglect, unconsented medical procedures, suturing of the perineum without anaesthesia, abusive care and lack of cultural safety. Women who opted for home birth under the care and supervision of elders shared positive experiences of childbirth in the form of care and support during delivery, freedom to choose birthing position, holistic care that transcends the physical as well as participation in childbirth rituals and ceremonies. Interviews with Indigenous midwives deepened an understanding of the conception of birth beyond physiology to include social, cultural, and spiritual dimensions. In their view, birth is not just a physiological phenomenon, but it is also a spiritual rite of passage. vii Research on obstetric violence often recommends solutions that seek to humanise medicalised birth without interrogating the impact of Western biomedicine which was exported to Africa during colonialism. This resulted in the suppression of knowledge and practice of Indigenous midwives. Countering obstetric violence without re-centering the knowledge and practices of Indigenous midwives constitutes a form of biomedical humanism (Gaines & Davis-Floyd, 2003) that upholds obstetric hegemony (Campo, 2014). In this thesis, I argue that responses to obstetric violence must 1) de-centre biomedical birthing as a site of obstetric violence, 2) decolonise midwifery by re-centering Indigenous model of childbirth, and 3) integrate cultural safety in the definition of safe birthing practices. I conclude that a call to counter obstetric violence is incomplete if it continues to silence the voices of Indigenous midwives and exclude their knowledge and practices.