Browsing by Author "Davis-Floyd, Robbie"

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    Birthing Between the “Traditional” and the “Modern”: DāĪ Practices and Childbearing Women’s Choices During COVID-19 in Pakistan
    (Frontiers Media S.A., 2021) Ali, Inayat; Sadique, Salma; Ali, Shahbaz; Davis-Floyd, Robbie
    Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DāĪ in the singular and Dāyūn in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews—5 with Dāyūn and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DāĪ and the doctor. We ask, what does the maternity care provided by the Dāyūn look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DāĪ has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dāyūn we interviewed, all from Pakistan’s Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dāyūn, like many others in Sindh Province, do not believe that COVID-19 is real—or are at least suspect that it is not. To contextualize the Dāyūn, we also briefly present local mother’s perceptions of the Dāyūn in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of “authoritative knowledge” and of critical medical anthropology, we highlight the dominance of “modern” biomedicine over “traditional” healthcare systems and its effects on the Dāyūn and their roles within their communities. Positioning this article within Pakistan’s national profile, we propose formally training and institutionalizing the Dāyūn in order to alleviate the overwhelming burdens that pandemics—present and future—place on this country’s fragile maternity care system, to give mothers more—and more viable—options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.
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    Editorial: The Global Impacts of COVID-19 on Maternity Care Practices and Childbearing Experiences
    (Frontiers Media S.A., 2021) Davis-Floyd, Robbie; Gutschow, Kim
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    Indigenous Midwives and the Biomedical System among the Karamojong of Uganda: Introducing the Partnership Paradigm
    (Frontiers Media S.A., 2021) Graham, Sally; Davis-Floyd, Robbie
    Certainly there can be no argument against every woman being attended at birth by a skilled birth attendant. Currently, as elsewhere, the Ugandan government favours a biomedical model of care to achieve this aim, even though the logistical realities mitigate against its realisation. This article addresses the traditional midwives of the Karamojong tribe in North-eastern Uganda and their biosocial model of birth, and describes the need British midwife Sally Graham, who lived and worked with the Karamojong for many years, identified to facilitate “mutual accommodation” (Jordan 1993) between biomedical staff and these midwives, who previously were reluctant to refer women to the hospital that serves their catchment area due to maltreatment by the biomedical practitioners. This polarisation of service does not meet that society’s needs. We do not argue for the provision of a unilateral, top-down educational service but rather for one that collaborates between the biosocial model of the Karamojong and the biomedical model supported by government legislation. We show that such a partnership is practical, safer and harnesses the best and most economical and effective use of resources. In this article, we demonstrate the role of the TBAs/traditional midwives and show that not only is marriage of the two systems both possible and desirable, but also is essential for meeting the needs of Karamojong women. The TBA is frequently all the skilled assistance available to these women, particularly during the rainy season when roads are impassable in rural South Karamoja. Without this skilled help, the incidence of maternal and infant mortality would undoubtedly increase. Ongoing training and supervision of the TBA in best practices will ensure better care. We offer a way forward via the Portable Partnership Paradigm (PPP) that lead author Sally Graham has created, the development and characteristics of which this article describes.
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    The Impacts of COVID-19 on US Maternity Care Practices: A Followup Study
    (Frontiers Media S.A., 2021) Gutschow, Kim; Davis-Floyd, Robbie
    This article extends the findings of a rapid response article researched in April 2020 to illustrate how providers’ practices and attitudes towards COVID-19 had shifted in response to better evidence, increased experience, and improved guidance on how SARS-CoV-2 and COVID-19 impacted maternity care in the US. This article is based on a review of current labor and delivery guidelines in relation to SARS-CoV-2 and COVID-19, and on an email survey of 28 community-based and hospital-based maternity care providers in the US, who discuss their experiences and clients’ needs in response to a rapidly shifting landscape of maternity care during the COVID-19 pandemic. One-third of our respondents are obstetricians, while the other two-thirds include midwives, doulas, and labor & delivery nurses. We present these providers’ frustrations and coping mechanisms in shifting their practices in relation to COVID-19. The primary lessons learned relate to improved testing and accessing PPE for providers and clients; the need for better integration between community- and hospital-based providers; and changes in restrictive protocols concerning labor support persons, rooming-in with newborns, immediate skin-to-skin contact, and breastfeeding. We address how changing practices and protocols influenced mother’s and providers’ wellbeing. We conclude by suggesting that the COVID-19 pandemic offers a transformational moment to shift maternity care in the US towards a more integrated and sustainable model that can improve provider and childbearer experiences as well as maternal and newborn outcomes.