Birth Models That Work

4. Samoan Midwives' Stories: Joining Social and Professional Midwives in New Models of Birth

119 Chapter 4 Samoan Midwives’ Stories Joining Social and Professional Midwives in New Models of Birth Lesley Barclay Utumuu INTRODUCTION This chapter challenges the assumptions, still held in many postcolonial countries, that the migration and replication of a Western model of birthing is necessarily a desirable goal. The system of maternity care left behind in the Pacific Rim as New Zealanders, Australians, French, or British colonialists moved out is at the very least disappointing. This chapter demonstrates how a group of leaders in one country, Samoa, have made considerable progress in both reconceptualizing and developing a “postcolonial” model of maternity care. Samoa is a small Pacific island nation northeast of Australia and New Zealand and over 3,500 kilometers west of Hawaii. It consists of two main islands with a small population of 176,848, as recorded in the 2001 census (Health Department Annual Report 2002). Samoans mainly live on these large islands and on a few other tiny islands. The total of births recorded across a range of health service facilities in 2002 was 3,264 (Community Health Nursing Information System [CHNIS]). Samoa’s birth model integrates social systems and practitioners with professional nurse-midwives in a model of health services delivery that appears to be unique. I describe in this chapter a new, non-Western birthing model that seems to work, and contrast this with my own experience as a midwife, midwife teacher, and maternity services consultant in Papua New Guinea and India over a decade ago and more recently in Jordan. In these countries , the Western professional culture dominates health care and birth rituals. These are imposed on normal birth, irrespective of local cultural values, evidence, cost effectiveness, and their capacity to increase risk. As data we have collected from traditional and professional midwives show, 120 l. barclay the experience in Samoa paints a much more positive picture and demonstrates a convincing and successful transformation from colonized birthing models. I would describe Samoa as developing a “postmodern midwifery” (Davis-Floyd 2004) and indeed a postmodern system of maternity care. Although this model is still evolving, it is more advanced in integrating social systems and practitioners with the advantages of professional health care than many others. “Informed relativism”—a key characteristic of postmodern midwifery (Davis-Floyd 2004; Introduction, this volume)—is played out in Samoa to the full in their rapidly evolving system of birth. The philosophy that underpins nursing and midwifery is Samoan and has repositioned cultural values and competence alongside professional competence (Barclay et al. 1998). This repositioning is unique and has significantly influenced professional development and behavior. The chapter explores these issues. I draw on research data and published work with Samoan colleagues with whom I have been working for fifteen years. I believe the Samoan model of birth illustrates a postcolonial birth system that is developing in ways that not only are economical and pragmatic but that also go beyond attention to physical outcomes to meet women’s individual needs for good spiritual, emotional, and social outcomes of birth as well—needs that are poorly recognized in Western systems of birth. BACKGROUND In the late 1980s, I worked on sabbatical for some months in India studying village-based systems of health care. During the visit, I spent a short time observing in a labor ward in one of the best hospitals in the country. I was interested to see how care was provided for those village women who chose or could afford to bypass the local, traditional midwives, who had been trained by the health system to provide village birth, a well-functioning and impressive service that I had also observed. The hospital had been established by a Christian church, was well supported, and was internationally connected: many members of its medical staff had studied in the United Kingdom, North America, or Australia. The hospital was a respected educational center for undergraduate and postgraduate medical, nursing, and midwifery students. Despite the international linkages and educational status of the hospital, I saw women “being delivered” without any social or family support—lying flat on their backs, undergoing routine episiotomy, being shaved of their pubic hair, and having their bowels emptied with enemas. That is, women were still receiving as “routine” the kind of nonevidence -based care that was unnecessarily distressing and did not improve outcomes (Barclay 1998). samoan midwives’ stories 121 A few years later, I was visiting the...