Changes in Childbirth Knowledge

Previous to 1940 fewer than 10-percent of women living in the western Navajo reservation gave birth in a hospital, but by 1970 the percentage of hospital births was nearly 100-percent (Kunitz 1976, 16). Leighton and Kluckholn stated in 1948, "Today an increasing number of Navajo women go to the Indian Service hospitals for delivery, but they still form a trifling portion of the total" (Leighton and Kluckholn 1948, 15). The greatest shift toward hospital birth occurred in the late 1950s. The implications of this shift are worth examining to increase understanding of Indigenous knowledge about childbirth and how it contributes to positive birth outcomes.

Infant mortality data is scarce before the introduction of hospital birth, though it appears it was high. In the late 1950s in the Many Farms–Rough Rock area of the Navajo reservation, Loughlin found the general infant mortality rate to be much higher than the national average. The neonatal mortality rate, however, was comparable or better than the national rate, in spite of the fact that only an average of 58.6-percent of babies were delivered in the hospital (Loughlin 1969). Separating the neonatal (within thirty days of birth) from the postneonatal (after thirty days of birth) infant mortality indicates that the neonatal deaths were comparable to that of the general population. This suggests that factors associated with childbirth itself were not the likely cause of the high infant death rate.

I was pregnant in 1979 and began to ask my mother-in-law about childbirth. She had sixteen children at home and was a deep well of information. The more I learned, the more my interest grew, and soon I was asking other women about their experiences. I was also in a doctoral program in public health, but I initially did not consider childbirth to be an academic subject. My motive for asking questions about childbirth was only my interest in the subject. As an Indigenous woman I had some anxiety about proving myself as a professional and did not think a "woman's subject" would improve my professors' perceptions of me. My passion for talking to women about childbirth did eventually lead to my doctoral dissertation (Begay 1985), though I have rarely spoken about the dissertation and have never sought to publish anything about it until now. I conducted lengthy interviews with twenty-one mothers who had given birth at home, most of whom were over forty years of age at the time of the interview. I also interviewed fifty women who gave birth in Navajo reservation hospitals. My methodology was anthropological, not survey based. Since I was a pregnant Native woman living on the Navajo reservation, I spent many hours sitting in Indian Health Service waiting rooms. I also went to chapter meetings, the Shonto trading post and Post Office, Enemy Way Ceremonies (sometimes called squaw dances), and the Shonto Bureau of Indian Affairs School where my daughter was a day student. I also worked on a number of community projects and attended community meetings. I was a participant observer, which is neither a method nor a kind of data, but it allowed me to spend many hours listening to women and their husbands talk about their childbirth experiences. The interviews with women began in 1979 and continued until 1983.

In 1955 the U.S. Public Health Service took responsibility for medical care on the Navajo reservation. At the same time increasing numbers of children were being sent to boarding schools for most of the year. Even though children were still being born at home in the 1960s, their older brothers and sisters were often away at school at the time. These school children knew that they had younger siblings born at home, but few of these children were actually able to observe the birth of siblings. A consequence of this was that knowledge about childbirth practices at home began to disappear. Since much information about life outside the purview of formal...