Open and Closed Knowledge Systems, the 4 Stages of Cognition, and the Cultural Management of Birth

This conceptual “think piece” looks at levels or Stages of Cognition, equating each of the Four Stages I examine with an anthropological concept. I equate Stage 1—rigid or concrete thinking—with naïve realism (“our way is the only way”), fundamentalism (“our way should be the only way and those who do not follow it are doomed”), and fanaticism (“our way is so right that everyone who disagrees with it should be either converted or eliminated”). I equate Stage 2 with ethnocentrism (“there are lots of other ways out there, but our way is best”). The next two Stages represent more fluid types of thinking—I equate Stage 3 with cultural relativism (“all ways are equal in value and validity”), and Stage 4 with global humanism (“there must be higher, better ways that can support cultural integrity while also supporting the individual rights of each human being”). I then categorize various types of birth practitioners within these 4 Stages, while showing how ongoing stress can cause even the most fluid of thinkers to shut down cognitively and operate at a Stage 1 level that can involve obstetric violence—an example of further degeneration into Substage—a condition of panic, burnout or “losing it.” I note how ritual can help practitioners ground themselves at least at a Stage 1 level and offer ways in which they can rejuvenate and re-inspire themselves. I also describe a few of the ongoing battles between fundamentalists and global humanists and the persecution that Stage 4 globally humanistic birth practitioners often experience from fundamentalist or fanatical Stage 1 practitioners and officials, often referred to as the “global witch hunt.

Indigenous Midwives and the Biomedical System among the Karamojong of Uganda: Introducing the Partnership Paradigm

Certainly there can be no argument against every woman being attended at birth by a skilled birth attendant. Currently, as elsewhere, the Ugandan government favors a biomedical model of care to achieve this aim, even though the logistical realities in certain regions mitigate against its realisation. This article addresses the Indigenous midwives of the Karamojong tribe in Northeastern Uganda and their biosocial model of birth, and describes the need British midwife Sally Graham, who lived and worked with the Karamojong for many years, identified to facilitate “mutual accommodation” between biomedical staff and these midwives, who previously were reluctant to refer women to the hospital that serves their catchment area due to maltreatment by the biomedical practitioners there. This polarisation of service does not meet that society’s needs. We do not argue for the provision of a unilateral, top-down educational service, but rather for one that collaborates between the biosocial model of the Karamojong and the biomedical model supported by government legislation. We show that such a partnership is practical, safer, and harnesses the best and most economical and effective use of resources. In this article, we demonstrate the roles of the Indigenous midwives/traditional birth attendants (TBAs) and show that not only is marriage of the two systems both possible and desirable, but is also essential for meeting the needs of Karamojong women. The TBA is frequently all the skilled assistance available to these women, particularly during the rainy season when roads are impassable in rural South Karamoja. Without this skilled help, the incidence of maternal and infant mortality would undoubtedly increase. Ongoing training and supervision of the TBA/Indigenous midwife in best practices will ensure better care. We offer a way forward via the Partnership Paradigm (PP) that lead author Sally Graham designed in conjunction with the Indigenous midwives and biomedical staff with whom she worked, the development and characteristics of which this article describes

Refusing cesarean sections to protect fertile futures:Somali refugees, motherhood, and precarious migration

While cesarean sections are increasingly used worldwide, Somali refugee women in Kenya are rejecting the operation in attempts to protect their future reproductive capacities. In a context of displacement and insecurity, women's reproductive bodies can be crucial to their security and strategies for onward migration. Somali women's resistance to C‐sections mirrors prevalent practices of female circumcision, since they are both perceived by physicians as medically harmful but by women as essential to achieving gendered expectations of marriage and motherhood. The strategic modification and protection of reproductive capacities are situated in multifaceted social and political ruptures, and women's refusal of surgery is part of a long‐term, future‐oriented pursuit of motherhood and survival

Birth as an American rite of passage

Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth - routines that can be insensitive, unnecessary, and even unhealthy? And why, in spite of the natural childbirth movement, has hospital birth become even more intensely technologized? Robbie Davis-Floyd argues that these obstetrical procedures are rituals that reflect a cultural belief in the superiority of science over nature. Her interviews with 100 mothers and many health care professionals reveal in detail both the trauma and the satisfaction women derive from childbirth. She also calls for greater cultural and medical tolerance of the alternative beliefs of women who choose to birth at home