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CHAPTER 10 Risks during Childbirth Kaya nogu, ng’wana nambu. It is easy to marry, but dif‹cult to give birth. —Sukuma proverb1 The meaning conveyed in the Sukuma proverb above is ambiguous. Should it be understood in a general sense, as in it is “dif‹cult to give birth” due to the risk of infertility and miscarriage, or that it is literally “dif‹cult to give birth,” due to the dangers inherent in the actual experience of childbirth itself? In this chapter we address the latter of these two interpretations and, in doing so, focus our attention on births that take place on the labor ward in the hospital setting and at Mwana Nyanzanga’s home in the village setting . Three aspects of childbirth will be examined: how labor and birth are managed, what happens when complications arise, and how the birthing woman is treated throughout the whole process. The Proper Way to Give Birth One of the things that struck me most about the majority of births I observed in Tanzania was the overall stoicism of the birthing women. Although childbirth in no way appeared to be pain-free, it nevertheless was not characterized by a lot of noise. Very rarely did a woman yell out loudly in pain, and if she did, she was quickly admonished either by midwives or nurse assistants on the labor ward or by Mwana Nyanzanga in the village setting. When, upon ‹nishing my ‹eldwork and returning to the States, I discussed the stoic nature of the births I had observed with a Tanzanian woman I knew, she spoke about such stoicism as if it were an inherent quality of rural women. She admired those women, she told me, because even in the face of their harsh living conditions, they persevered, especially 187 during childbirth. These were qualities she felt she wouldn’t be able to exhibit were she to live in a similar environment. Another Tanzanian woman I knew, who lived in Australia but was visiting relatives in Dar es Salaam when I met her in 1992, also spoke about women’s stoicism during birth as a trait to be admired. She recounted her own experience of giving birth in an Australian hospital: “I gave birth like an African woman!” she told me, her voice ‹lled with pride. She noted that her ability to remain relatively quiet throughout labor and during the actual birth was met with surprise, but admiration, by the Australian nurses attending her. Women living in Bulangwa were also of the opinion that a woman should be stoic during childbirth—it was the proper way to behave. Never having given birth myself, many of my ‹rst conversations with women about childbirth focused on whether the whole process was painful. All assured me that it de‹nitely was. Well, then, how were they able to keep from crying out? I would ask, adding in the same breath that were I to give birth some day, I didn’t think I would be able to keep quiet. In fact, I often told them, I would probably yell rather loudly. After assuring me that “of course” I would give birth some day, and then joking they would enjoy seeing the spectacle of my giving birth and “threatening” to chastise and hit me if I cried out, they gave several reasons why a woman must remain calm during labor (see Sargent 1982). Some women explained that crying during labor was aibu, a shameful way to behave. One older woman noted that it was bad to call out and cry during labor because if people heard you, they would think you were having problems. Another common explanation was that a calm demeanor during labor prevented harm to the baby. Still other women would scoff at the idea of yelling out during labor, noting that the woman had “enjoyed” herself during the baby’s conception , so why should she cry about it now? The Proper Way to Manage Birth My experience as a lay midwifery trainee in El Paso, Texas, initially constituted for me the norm against which I evaluated the births I observed in Tanzania. As a result of that ‹ve-month training, I had come to view certain features of labor and birth management as essential: regular monitoring of the pregnant woman’s vital signs during and after labor and of the baby’s before and after birth, combined with positive reinforcement and 188 Managing Motherhood, Managing Risk [52.14.85.76] Project...

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