Professionalizing Midwifery: Exploring Medically Imagined Labor Rooms in Rural Rajasthan

Abstract

In India, globalized flows of biomedical discourse like evidence-based delivery practices (EBDs) and new technologies are reshaping the field of reproductive health care. As iterations of evidence-based medicine shift, non-governmental organizations (NGOs) increasingly act as distributive agents for biomedical projects that equate modernized health care spaces and provider-care techniques with a marked improvement in the safety of birth outcomes. In this article, I examine how particular local iterations of EBDs are distributed to skilled birth attendants (SBAs) who have become sites for globalized projects aimed at reshaping their professional designation. I draw on data collected through in-depth ethnographic interviews with SBAs practicing in health centers around southern Rajasthan to explore the dynamics and tensions surrounding the professionalization of midwives and the increasing promotion of EBDs in institutional labor rooms.

Author biography
Sara Price trained in medical anthropology at Oregon State University and conducted fieldwork in Rajasthan, India. After conducting research on shifting birth practices in India, she moved to a clinical focus. Sara is currently at the Yale School of Nursing, training as a Nurse Practitioner in women’s health and nurse midwifery. Sara’s research interests focus on negotiating the overlap between the clinical practice of midwifery and women’s health utilizing an applied critical medical anthropology approach to care and research.

Additional publication by the author
Forber-Pratt, I.A., Loo, S., Price, S., &; Acharya, J. (2013). Foster Care in India: An exploratory survey of the community perceptions and prospects for implementation of foster care in a developing nation: A study in Udaipur, Rajasthan, India. Children and Youth Services Review, 35(4), 694-706.

Editorial footnotes
Medical Anthropology Quarterly has published several articles discussing issues surrounding the implementation of evidence-based practices and biomedical knowledge in maternal and neonatal care, including Katerini Storeng’s and Dominque Béhague’s (2014) “Playing the numbers game”: Evidence-based advocacy and the technocratic narrowing of the Safe Motherhood Initiative, Claire Wendlend’s (2007) The Vanishing Mother: Cesarean section and “evidence-based obstetrics”, and Cecilia Van Hollen’s (2003) Invoking Vali: Painful Technologies of Modern Birth in South India.

Medical Anthropology Quarterly has also published several articles describing the professionalization of midwifery in different contexts including Nancy Triolo’s (1994) Fascist unionization and the professionalization of midwives in Italy: A Sicilian case study, Margaret Macdonald’s (2006) Gender Expectations: Natural bodies and natural births in the New Midwifery in Canada, and Christa Craven’s (2005) Claiming respectable American motherhood: Homebirth mothers, medical officials, and the state.

Photo by Anurag Agnihotri. From flickr. Open source photo used in accordance with Creative Commons license.

Photo by Anurag Agnihotri. From flickr. Open source photo used in accordance with Creative Commons license.

Interview with the author
1. How did you become interested in the professionalization of midwives and promotion of evidence-based delivery practices in Rajasthan?

I began studying the anthropology of birth during my master’s program. When I first traveled to India, I was assigned to a non-government organization (NGO) research partner to evaluate health care providers and their use of evidence based care practices. In watching the actual implementation of these practices, I became fascinated by the clear disjuncture between practice and protocol and that was the jumping off point for my work.

2. What challenges or surprises occurred while setting up and conducting your fieldwork?

What always surprises me about conducting fieldwork is how important it is to observe. So often we get distracted in the way individuals describe what they perceive as what we, the researcher, wants to hear. If we watch and look at the disjunction between what is said and what is performed we really can learn so much that can inform our work.

3. In your study, you worked with an NGO to study their midwifery training program and issues with promotion of evidence-based delivery practices. What were some of the challenges or rewards of working with an organization that you are concomitantly studying?

The most challenging part of working with NGOs is the disconnection between community-driven goals and objectives and those laid out by funders. In the case presented in this paper, the funding dictated the research questions. Results that weren’t pertinent to those questions really weren’t considered valuable.

Questions for classroom discussion
1. How does the author apply DelVecchio Good’s (2010) concept of the “medical imaginary” in this article? What specifically contributes to the belief of the labor room space as “universally synonymous with a safe and speedy delivery” (p. 523)?
2. What are some of the barriers the author identifies to implementing the evidence-based delivery practices?
3. What are the power structures or hierarchies that emerge during the labors and deliveries described in the article?
4. How do NGOs, either in this article or in other examples/articles, act as “a regulatory apparatus of biomedical discourse” (p. 532)? What, if any, role do you think NGOs should be playing in the training of providers (midwives, community health workers/volunteers, traditional practitioners, etc.) in low-resource settings?
5. Based on the information presented in this article, what recommendations would you make to the NGO or to another NGO considering providing skilled birth attendant training in evidence-based delivery practices?