Letter to Midwifery Matters

I would like to make three responses to the last edition of Midwifery Matters.

1) I found Nessa McHugh's simple use of the word sacred to describe birth very powerful and moving. I have been thinking around the subject for many years and she made me realise this sacredness with a new force: 'something that is so commonplace is also truly extraordinary.' Thank you.

2) This may seem a trivial point unrelated to midwifery, but as a pedant and a Buddhist practitioner I feel I must make it: three articles in Midwifery Matters used the word mantra essentially to mean an unthinking acceptance of orthodoxy. Mantras are used extensively in both Hinduism and Buddhism: they are a religious practice and their repetition is designed not to enhance unthinking acceptance of dubiously based beliefs but an altered state of consciousness intended to broaden rather than narrow the mind.

3) Beatrice Carla, in her very interesting article on Nepal, referred to the belief that the placenta might rise up into the woman's throat. Jo Murphy-Lawless in her fascinating book on the development of obstetric thinking Reading Birth and Death states that a similar belief is widespread throughout the world. She describes a community in the remote high Andes of Bolivia where women will normally choose traditional midwives to be present for their first births but after that they will give birth alone, assuming they believe that all is well - and these women have highly developed skills of self palpation and diagnosis of malpresentation and their traditional midwives have a range of interventions to correct malpresentation - and after the baby is born the woman's husband will come in to help deliver the placenta. He will cut the cord and use a special thread to tie the placenta end to the woman's toe, she will tug gently while massaging her sides and abdomen, and he will put a specially embroidered belt around her waist to prevent the placenta rising up. These beliefs seem bizarre to us, but Jo Murphy-Lawless puts them in the context of a non literate society with no access to electronic mass media. She describes a similar belief held by similarly illiterate midwives in Ireland in the 18th-century. What these people bring to their understanding of childbirth is their experience and their imagination. They know that if the placenta is not expelled there will be trouble which may well result in the death of the mother and they do not have the exact anatomical knowledge which we have - and which we derived to some extent as the result of the dissection of the bodies of women who died in childbirth and whose dissection contributed to the further deaths of women before the understanding of asepsis was properly accepted.

Yours, Meg Taylor