By Hillary Melchiors, Ph.D., MPH, LCCE, CD(DONA)

When Birth in Eight Cultures was published earlier this year by Waveland Press,  I knew the perfect person to review this book.  Medical anthropologist Hillary Melchiors is also a Lamaze Certified Childbirth Educator and DONA certified Birth Doula.  Hillary's academic knowledge along with her years of experience as a birth professional meant that she could provide a solid review and let us all know what to expect from this exciting new book.  I am delighted to share Hillary's review along with her conversation with editor Melissa Cheyney, Ph.D., CPM, LDM today on the blog. - Sharon Muza, Connecting the Dots Community Manager.

Introduction

Updating a classic academic text might be overwhelming for some, but the collaboration of three generations of anthropologists who focus their research on reproduction and childbirth makes Birth in Eight Cultures not only an important contribution to anthropology but also for anyone wanting to better understand what really shapes birth practices. The authors point this out at the very beginning of the book. “The cross-cultural study of how societies perform birth can operate not only as a critical lens into much deeper understandings of any given culture but also as a means to a clear understanding of how deeply culture—far more than science—influences childbirth (p5).” This book might have been written for anthropology undergraduates, but childbirth professionals at all levels would certainly benefit from reading it.

Overview

Beginning with a brief introduction into the anthropology of birth, this book dives deep into comparing birth practices and policies across and within cultures around the world with contributions from researchers who are on the ground using multiple different methods for better understanding the cultural patterns of how childbirth is handled in their different settings. Lydia Zacher Dixon, Vania Smith-Oka, & Mounia El Kotni help us explore three different models of childbirth in Mexico from the technocratic model of hospital birth to two different midwifery models of care: professional and traditional. Megan Cogburn, Adrienne Strong, and Summer Wood take us on a journey through Tanzania where they look at choice, policy, and location in the face of a changing cultural landscape. K. Eliza Williamson & Etsuko Masuoka compare the vastly different maternity care systems in Brazil and Japan, specifically focusing on how cross-cultural collaboration can change practices and viewpoints. Similarly, Eugenia Georges and Rea Daellenbach take the reader on a comparative journey between the cultural models of maternity care in Greece and New Zealand, illustrating how cultural values influence choice and ideas of how things should be done. Melissa Cheyney, Bahareh Goodarzi, Therese Wiegers, Robbie Davis-Floyd, and Saraswathi Vedam finally compare giving birth in the United States and the Netherlands, especially as it relates to choice in provider and place specifically focusing on how ideologies influence the perceptions and practices of childbirth. Chapter seven is full of stories from the researchers about the research process, ethical issues, and how challenging participant observation is as a methodological approach. The final chapter summarizes the contributions of all the authors and gives direction for the future.

Themes

The themes of this book all center on the role of cultural influence on how birth happens including the hidden curriculum of learning how to help people give birth, choiceless choice in the push for “modernization,” place as a factor in provider behavior, and the technological imperative that if technology is present it must be used along with the obstetrical paradox that intervening to keep birth “safe” often causes harm. These chapters all explore the cultural variability between types of care from too much, too soon to too little, too late, while also advocating for the right amount at the right time in all cultural contexts. The greatest contribution of this collection of research is that the reader is able to see that culture is the defining force that is shaping maternity care, and decisions that are supposed to be based on evidence are still strongly influenced by culture in the end.

For Childbirth Professionals

The nexus of culture and health is the focus of medical anthropology, and this text is an outstanding representation of how this field can contribute to our understanding of childbirth practices around the world and in our own backyard as childbirth professionals. This book not only takes us on a journey around the world to look at how culture shapes the practice of other places but also focuses on understanding how our childbirth choices and practices are shaped by our cultural values. When I asked Dr. Cheyney what she sees as the greatest value of this book for childbirth professionals she said it is most definitely the cross-cultural lens it brings! “When we’re on the ground, it is easy to get tied up in U.S. exceptionalism. The U.S. is not so different and we need to talk about the complexity of other countries and how their nuance can shape the formation of our own system in larger conversations. The U.S. should be learning from that.”

Dr. Cheyney, who works as a Certified Professional Midwife in addition to being a professor of anthropology at Oregon State University, views herself as a bridge builder within systems of care, and many childbirth professionals think of themselves in the same way. Dr. Cheyney sees this collaborative volume as an opportunity to build on the shoulders of her academic giant predecessors while highlighting their voices and perspectives at the same time. Childbirth professionals will take away a better understanding of how to ask systems-level questions, instead of focusing solely on individual actors within those systems. Dr. Cheyney also truly hopes that the book illustrates the importance of midwifery care and making sure we set up systems so that people can have access to the level of care that is appropriate for their needs, even within a system that contains historical structural issues, such as the influences of colonialism and racism for example.

Recommendation

I highly recommend this book for all childbirth professionals, and not just because I am a medical anthropologist myself. This book is quintessential reading for anyone who is at all critical of the maternity care system where they live and will most likely shift the way you think about what influences systems for birthing people. This book not only builds on the original seminal work Birth in Four Cultures by Brigitte Jordan, but also bridges the gap between multiple generations of people trying to change birthing policies around the world while illustrating the cultural influences that shape our very thought processes about how they should look in the end. The research contained herein is an excellent representation of not only what medical anthropology and cross-cultural research brings to the discussion of systemic change, but also how collaboration between paradigms, cultures, and generations can help us all reach a shared vision for improving maternity care and birth in a more culturally salient way wherever we are located.

About Hillary Melchiors

Hillary Melchiors, Ph.D., MPH, LCCE, CD(DONA) holds a Ph.D. in Medical Anthropology and a Masters in Public Health from Case Western Reserve University. Since 2014, she has worked as a DONA birth doula and Lamaze childbirth educator in Evansville, Indiana and is the owner of the Doula Group of Evansville.

Published: April 23, 2019

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