Childbirth, despite being universal, is a very cultural process. While women all across the world give birth each day, the experience a woman has delivering her baby varies; the location, protocol, and agency of the mother during childbirth is determined by one’s personal health background, their access to resources, cultural traditions and taboos, power hierarchies, and largely by who has ‘authoritative knowledge’.

Brigitte Jordan discusses the concept of authoritative knowledge in her 1992 article, using the instance of a high-tech American hospital birth as an example phenomenon to dissect. In her analysis of the labor and birthing process, Jordan highlights the seemingly insignificant nature in which the mother’s desire and bodily imperative to ‘push’ is regarded, by health professionals and assistants alike. Despite her intuitive logic urging her to expel the baby from her body, the process is halted by the medical staff (who vigorously check the scientific readings of EFM machine and put off the delivery with Lamaze breathing) until the official ‘say-so’ is given by the physician to begin pushing (Jordan 1992). In this scenario, childbirth is medicalized and the physician acts as the exclusive source of power in the delivery room; their training, intelligence, interpretation of scientific readings, and personal intuition is valued above all others (especially to that of the birthing mother). This is not always the case in other countries.

In Benin, the birthing process is very different in the north and south. The Bariba people of the north believe that traditionally preferred labor and birth should occur alone and in the home with no attendants (i.e. midwives, health professionals, etc.). These birthing mothers hold the decision-making power, and they are expected to showcase independence and remain stoic in the face of pain to avoid communal shame (Sargent 1989). During labor, these women are supposed to go about with their normal days without alerting anyone that labor has begun, and it is their authority alone that they consult as they give birth; these women are known to request assistance only when it is time to cut the umbilical cord. Even in more high-risk cases, outside intervention is opposed, and the advice of an older woman is usually as ‘professionalized’ as Bariba women will accept from outside attendants/assistants (Sargent 1989). Birth is viewed by Bariba women as being natural and not pathological, making the presence of a specialist or physician wholly unnecessary.

Women of the more urbanized south are much more likely than their northern counterparts to give birth in a hospitals or other healthcare facilities. Statistically speaking, an entire 97% of women in the southern areas of Cotonou, Porto Novo, and their surrounding areas deliver in health facilities. Birth attendants that Beninese women are most likely to encounter during the course of their pregnancy is a midwife, most who are females that have completed a three-year education in the major city of Cotonou (Harvey, et al. 2004). In health facilities, staff physicians also assist in birthing rights and supervise midwives during cases with complications. In these environments, advanced medical intervention is coupled with a lack of privacy, restrictions on who can accompany a woman into the delivery room, and the undeniable authority of the hospital staff. In this way, these more technologically advanced facilities serve as both a benefit and a hinderance on the birthing process for Beninese women. Culturally, the Fon people of the south are taught to embody the pain of labor by crying out and moving in response to it, in order to speed delivery and show the father of the child the extent to which the woman is suffering for the birth of their child. Often, this mobility and presence of the father at delivery can be overruled and prevented by facility regulations and the authoritative knowledge of healthcare physicians.

Pregnancy (and birth) is a way to gain status and respect in Beninese culture, but birth is also described as a time of extreme vulnerability, or ‘where life and death converge’ (Grossmann-Kendall, et al. 2001). As Western biomedicine gains dominance and authoritative knowledge is increasingly being valued from medical professionals, the voices of birthing women in Benin are being ignored and their cultural comforts (such as their privacy, preferred birthing position, location of labor, and attendance at delivery) sacrificed for the perceived promise of improved maternal health.

References

Grossmann-Kendall, F., Filippi, V., De Koninck, M., and Kanhonou, L. 2001. “Giving Birth in Maternity Hospitals in Benin: Testimonies of Women.” Reproductive Health Matters 90-98.

Harvey, S.A., Ayabaca, P., Bucago, M., Djibrina, S., Edson, W.N., and Gbangbade, S. 2004. “Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.” International Journal of Gynecology and Obstetrics 203-210.

Jordan, Brigitte. 1992. Technology and Social Interaction: Notes on the Achievement of Authoritative Knowledge in Complex Settings. Institute for Research on Learning.

Sargent, C.F. 1989. Maternity, Medicine, and Power: Reproductive decisions in urban Benin. Berkeley: University of California Press.