As a young wife and mother, having grown up in the US, I came to India anxious to learn as much as I could about this unknown land. Little did I know that that same curiosity would propel me to become a full-fledged researcher. I started out teaching natural childbirth classes, as a few pregnant friends and their doctors were interested in childbirth preparation – learning techniques to avoid medication and surgery.
Gradually, I became disenchanted with many obstetricians’ overuse of invasive obstetrical methods routinely, not allowing time or giving needed support to mothers for allowing babies to be born ‘naturally’. It became a moral dilemma for me - how could I continue teaching childbirth preparation classes when doctors were not permitting women to use the tools (breathing, massage, relaxation) I was imparting?
Tradition Vs modernity
Thus began my career as a researcher. Not that I hadn’t attended university and studied social sciences, but my REAL learning began on the ground, following my own curiosity. I started by teaming up with New Delhi-based NGOs. We interviewed women from all strata (slum residents, middle and upper class) about their experiences of pregnancy and birth.
What came as a huge surprise to me was the fact that the lower class women, who clung to certain ‘traditions’ including notions of pollution or uncleanliness during menstruation and postpartum bleeding, expressed more positive associations with birth than did the more ‘privileged’ women who had doctors determine meanings and processes of having a baby.
I was hooked, curious and questioning. What were these traditions? Why was there such a schism between the English-educated, medically-cared-for upper crust and the slum dwellers (many being migrants from Uttar Pradesh and Rajasthan), who functioned much more from ‘tradition’ and mostly used dais (midwives)? And what were the fundamentals of care-giving and ritual practice which facilitated the positive experiences these women were reporting? I’ve spent the better part of 25 years trying to answer these questions.
India is known globally for ancient and sophisticated mind-body and healing techniques such as yoga, meditation, herbal cures, Ayurveda and Unani. But when women and birth are involved, the ancient practices are not worth keeping, or so the propagandists would say! So in parallel with researching traditions, I also studied colonial history which explained the vast differences between the English-educated, elite attitudes and those of dais and their clientele.
Bias against dai
Historically, there were two streams of biases against dais. On the one hand, Indian dietary, herbal and hands-on birth practices were criticised by British colonial writers seeking to assert the superiority of western and ‘modern’ medicine – what we would today call obstetrics.
On the other, exists the caste system that we cannot really blame on the British, though they did reinforce it in their attempts at governance. Although dais (or suins, bais, sugalithis – there are many terms in various regional languages) may come from different communities, by and large they occupy the bottom of the caste pyramid. Tradition deems the birth and postpartum bodily processes as ‘polluted’ or ritually impure.
These beliefs rendered the mother (temporarily) and the dai (permanently) ‘unclean’ according to strict Hindu, Muslim and often Christian and Sikh customs. For this reason also, dais suffer from the ignominy of young women not wanting to follow in their footsteps, seeing the handling of birth as ‘dirty’ and humble work.
However, India being such a varied land, traditional techniques and orientations towards birth and female physiology persist. And, as mentioned above, such techniques are practised by dais or family members mostly in poor urban and rural settings.
Ironically, in the US and Europe, some of these traditions and techniques of birthing are gaining ground. Homebirth, continuous presence during labour, emotional support and massage, delayed cord-cutting are all being rediscovered in the West – and scientifically validated as ‘evidence-based practice.’
Learning from the dais
I started MATRIKA, an NGO that researched and advocated for dais and their birth traditions. We did workshops with dais in four areas of North India, asking them to ‘train us’ in their methods and rituals. Of course, they at first thought that our real agenda was to train them. The dais finally became convinced of our intention to learn from them when we did a role-play of a woman labouring alone in a hospital and being treated roughly by the overworked staff.
Our team learnt so much over those three years and my respect increased for these old ladies (most of whom were quite elderly in part because younger women, even from their own families, would not take up the work that they saw as demeaning. They preferred factory or other jobs). Out of MATRIKA came a website, a film and an edited collection on birth called ‘Birth and Birthgivers: the Power Behind the Shame’.
Ayurvedic practices of dais
Besides these ancient birth traditions being ‘validated’ in the West, amazing correlations in knowledge and practice exist in two very separate streams of Indian maternal health traditions: Ayurvedic texts and the traditional midwives. Historically, there was no known exchange between these two groups.
Vaidyas were high caste, literate and mostly males; whereas dais were low caste or outcasts, illiterate and mostly females. And these maternal health ideas, common to both dais and Vaidyas, were not exclusive to the ‘professionals’ – often they were also householder understandings of female physiology and women’s needs.
Central to both dai and Ayurvedic traditions are the importance of the use of warmth or heat and oil – both pre-and post-partum.
Jeeva, an innovative research project documenting childbirth and dais’ practices, conducted a pilot project in Bokaro district of Jharkhand, interviewing popular midwives respected by their communities for their expertise. Ratna Devi was one of those interviewed. When asked how she helped a labouring woman, she responded,
“When the woman started having pains, I went to her home, heated water and gave her hot water to drink. Then I poured oil over her belly and massaged it gently. I would give hot water or tea to the labouring woman to increase the labour pains, and to also give warmth to her belly.” The ancient vaidya Charaka, in his book Charaka Samhita, also recommends that warmth and oil be administered to the labouring mother.
He says: “When it appears that there are signs that birth is near, then her body should be anointed with oil and washed with warm water and she should be made to drink a hot gruel made of beneficial articles.”
A comparable regimen of warmth and oil followed in both Ayurvedic and dai traditions during the postpartum period. As the dai Abola explains, “After birth, because of bleeding, everything is kuchcha (raw) inside the mother’s body. So warm water is given to her to drink for 21 days.” Jaitun Bibi, another dai, says, “After the birth, I apply oil to the mother’s belly and give a hard rubbing with my hands. For the next six days, we go to the new mother’s house to apply oil on her and apply sek (dry heat).” Similar handling of the postpartum mother is prescribed by Charaka Samhita: “She is empty due to growth of foetus, pain, discharge of fluids and blood, she should be treated properly with oil massage, warm food and drinks.”
Unfortunately, dais and many of their traditional methods are dying – endangered by lack of government inclusion in health programmes and because their daughters and granddaughters are not taking up the work. Surely others should learn from the dais’ useful indigenous practices!
Current interest in ‘natural childbirth’ both abroad and in India can be facilitated by knowing more about dais and their techniques.
It is not necessary that only the dais’ offsprings should continue with their practice. Maybe they can pass on their wisdom to others, and we can try to learn from them and adopt their many useful, indigenous practices.
As some in the West seek to birth ‘naturally’ at home or in the hospital, with midwives, supported by massage and encouragement, we in India are often allowing our traditional practitioners to pass into history.
The challenge is to place the mother, not an institution, at the centre of the birth process wherever the birth takes place. This was the attitude of traditional caregivers and hopefully will be carried into the future.
Tips for would-be moms:
So how can prospective and new mothers learn from and apply some of these techniques? My suggestions are these:
Keep warm: As birth time approaches, stay as warm as possible (doesn’t mean hot and uncomfortable—just warm). Continue the same for a few days postpartum. Avoid cold drinks and food. Dais would also suggest easily digestible food postpartum. As all the body’s energy has gone into having the baby, digestive ‘fire’ is less.
Be active: Don’t stop moving (walking, dancing, working) before the birth. Moving during labour also helps the process. Stay as fit and active as you were before being pregnant. Be sensible though—no yoga headstands, marathon running, or wild gym sessions.
Binding the tummy: Tradition would have the tummy bound postpartum (as the old ladies used to do). Doctors would say ‘use your muscles’—but everything, bones, ligaments, muscles, organs, have moved in baby-making. A little outside support is a good thing.
Oil massages: Have light oil massages pre and postpartum. But make sure the masseuse has experience with parturient women.
Be intuitive: Listen to aunties, grandmothers, other elders, women who work in your home, but do what YOU feel/think is best. And ask questions like ‘How will this help me?’ Trust your intuition. Finally, it is your body/self which knows what is good for you and makes you feel good—dais, doctors, elders, this writer are all making suggestions.
Janet Chawla, an American by birth, has lived and worked in India for 30 years. She is the mother of three children, and the delighted grandmother of four. She is currently the director of Matrika, an ngo active in research and advocacy for humane and traditional birth practices.