Still today, traditional healers and midwives skilfully integrate the ancient healing arts of massage and midwifery, as they have for thousands of years. By Erika Kruger

Modern day midwife, Kara Maja Spencer, describes prenatal massage and compassionate touch during the childbearing year as more than a primitive practice or luxurious pampering; it is an essential and vital part of holistic maternity care 1.

“Before Western medical practices displaced traditional midwifery, the touch and massage of a midwife or birth attendant was the central component of prenatal care around the world. In the absence of obstetrical tools and gadgets a midwife had her eyes, ears, and hands to diagnose and assist pregnant women. Honed by constant practice the midwife’s senses of observation and intuition through touch were finely tuned. Today, traditional healers and midwives skilfully integrate the ancient healing arts of massage and midwifery, as they have for thousands of years.2

THE ROLE OF MIDWIVES

A qualitative investigation of traditional midwives in Botswana has profiled her as a woman who is socially and culturally integrated into the local community; represents a highly valuable source of information on cultural conceptions of crucial importance to childbearing Batswana women; demonstrates the value of a close personal relationship and communication with the delivering woman; realizes the limitations of her own capacity in birthing situations; and maintains close links with and makes referrals to the local hospital where indicated 3. The prototypical traditional midwife who was the focus of this study was a 48-year-old Batswana woman who had attended over 350 births since 1971. Among her roles were pregnancy diagnosis, assessment of nutritional intake, counselling regarding the side effects of pregnancy massage of the abdomen, delivery, assessment of the newborn, cord care and cultural rituals. After delivery the traditional midwife makes home visits to follow up on vulnerable populations and encourage use of family planning to space births.

MASSAGE IN PREGNANCY

Massage plays an important role in preparing Nigerian mothers for childbirth.  The traditional birth attendant (TBA) in , as in other parts of Africa , often does not have formal schooling and acquires her skill and knowledge from either a relation or friend by means of an informal apprenticeship 4. In contrast, the midwife has a formal, basic and professional education and can only practice independently after passing the prescribed national examination and being registered by the Nigerian Nursing and Midwifery Council.

The midwife is responsible for the care of the woman during the antepartum, intrapartum and postpartum period. From the 3rd month of pregnancy onward the midwife will carry out regular abdominal massage and palpation. This technique is used to loosen the nerves and relax the muscles, facilitating an easy pregnancy and delivery as well as correcting malpresentations. The mother-to-be will also make a paste with kola nuts and rub the paste on her abdomen every day to prevent thrush and other skin infections in the newborn baby.

After birth, the placenta is disposed of with care because it is regarded as part of the baby even after birth. The mother is given a warm bath and a specially prepared oil is applied over her body. The abdomen is bound tightly with a cloth believing it will help the abdominal muscles regain their tone and maintain the pre-pregnancy figure.

As is the case with traditional bone setting, there often exists a conflict between the traditional and Western treatment of pregnant, peri and post-natal women. Research done in the riverine areas of Southern Nigeria 5 confirms that abdominal massage is an age old practice among obstetric and non obstetric patients. The researchers however consider it “a silent killer” that has contributed to maternal and peri-natal mortality and morbidity in this region. They blame ignorance, illiteracy and poverty as well as underdevelopment, inaccessibility and ill-equipped medical facilities for the sustained support for this practice ”even amongst the educated group”. They propose that it is time to stop this form of avoidable losses through public health approach; mass literacy; even distribution of affordable healthcare services; improved social services and transportation; robust economy and a grass root involvement of rural programmes aimed at eradicating this “harmful traditional practice”.

CARING WITH MASSAGE

A paper examining the cultural acceptability of biomedical obstetrical services and care among women in North Cameroon 6 show that cultural acceptability of biomedical services is impaired by a series of requirements such as a too early first prenatal visit; the absence of traditional healing like massage after delivery; refusal to hand over the placenta and umbilical cord to the family; and hindering the presence of family members during delivery. According to the researchers these evidences support a transition from normative medical system to an efficient and flexible medical system that is congruent with the expectations of the population. In other words, patient-centred care.

MASSAGE IN MIGRATION

Even when residing in a foreign country, the transition from a traditional healthcare system to a biomedical system is not immediate nor absolute. A study on the various kinds of behaviour in mothering and the ways of taking care of children by 26 migrant mothers coming from West Africa was carried out in order to evaluate and analyze changes in these practices when coming into contact with French society 7. Massage techniques and posturo-motor exercises, as well as the physical contact between the adult and the child, and breast-feeding were examined. The researchers came to the conclusion that acculturation can be rapid in the ways children are fed but that massage techniques and bodily exercises, which are bound up with the way the child and its development are perceived, are harder to change. They also noted that children having gone through these exercises walk significantly earlier than those who haven’t.

MASSAGE MEDIATES SOCIAL BIRTH

Massage as a ritual for newborns is more that just a physical experience. Mannoni 8 refers to traditional customs and practises as asocial birth. The author explains that bodily practices on newborns are the indicators of communication between the child and his/her surroundings. It is culture that has to introduce the baby into a specific group through practices or traditions that have been used for generations. The relation between the identity and the culture is illustrated by the practice of massage on newborns by their grandmothers in the Bambara region in . The grandmothers massage and stretch the newborns to let them experience the limits of their bodies and in the process to get into the Bambara identity. Mannoni explains that the psychic structuring and the culture are tightly connected and the body is the first mediator of that representation.

REFERENCES

  1. Maia Spencer, K, (2004) Midwifery Today, Summer 2004 http://www.genxmom.com/kara/archives/001094.html
  2. Ibid
  3. Anderson , S. (1982) Traditional midwifery: a case study. Trop Geogr Med. 1982 Mar;34(1):91-101.
  4. Iwese, F.A. Taboos of childbearing and child-rearing in Bendel state of .
  5. Ugboma H.A. & Akani C.I. Abdominal massage: another cause of maternal mortality. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Port Harcourt, .
  6. Beninguisse, G. & De Brouwere, V. (2001). Tradition and modernity in : the confrontation between social demand and biomedical logics of health services. Arch Pediatr. 2001 Aug;8(8):882-8
  7. Rabain-Jamin, J. & Wornham, W.L. (1985) Changes in maternal behaviour and care practices in migrant women from Western Africa . Botsw Natl Health Bull. 1985;1(1):64-75.
  8. Mannoni, C. (1995). Role of bodily practices with newborn in the development of cultural identity. Examples of bodily practices in Africa and . East Afr Med J. 1995 Oct;72(10):623-5.