Birth on the Threshold. Cecilia Van Hollen
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into its medical schools, and the first city with a medical school offering a post-graduate diploma in obstetrics and gynecology. It was, therefore, no surprise that in 1936 the first All India Obstetrics and Gynaecological Congress gathered in the Museum Theatre in Egmore, Madras, just down the road from the Egmore maternity hospital. Ida Scudder, an obstetrician and gynecologist—born into a missionary family in South India—who helped to found the world-renowned Christian Medical School and associated hospital in nearby Vellore, was elected the first president of this congress. In her welcoming address, the chair of the congress, Dr. A. Lakshmanaswami Mudaliar, proudly stated:
Madras may not stand comparison in many respects with the Gateway of India or with the City of Palaces—the second largest city in the British Empire. But Madras is proud[,] and justly so, of the place it occupies in the Obstetric world of today and it is in no spirit of narrow provincialism that I venture to maintain that no other city in India could have claimed this honour with greater confidence and dignity.7
Prior to the 1844 opening of the Government Hospital for Women and Children, women in India had all been delivering their babies at home, usually in either their natal home or their husband’s family’s home. There were medical institutions for indigenous medical traditions (such as Ayurveda, Unani, and Siddha), and these traditions did have well-developed theories of reproduction and birth.8 However, these indigenous medical institutions and practitioners were not involved in providing services to women during the actual birth. Some have suggested that this is largely due to the fact the practitioners were almost all men and it was inappropriate for a man to be present at a birth.9
Many of the home deliveries were overseen by senior female members of the extended family who had experience in assisting births. Other deliveries were attended by lay midwives who were called from outside the family. In South Asia these midwives are often referred to collectively as dais by people writing about the region as a whole. This term is most widely used in the northern regions of South Asia and is thought to be of Arabic origin.10 Some scholars have chosen to use the term “traditional birth attendant,” or “TBA,” which is taken from the international development discourse, because the term “dai” is deemed condescending in the communities they are studying.11 Indeed, in much of the literature on midwifery in India the primary role of the dai is thought to be the removal of ritual “pollution” associated with childbirth. In particular, writers mention that the cutting of the umbilical cord and the disposal of the placenta and blood are the primary tasks performed by dais and that these tasks are deemed defiling. In general, specialized dais belong to low-caste Hindu or poor Muslim communities. Many dais are members of the “barber” castes, which participated in an extensive network of patron-client, or jajmani, relationships in the precolonial era.12 The work of the dai is often hereditary, passed on from mother-in-law to daughter-in-law.
Unfortunately, discussions about the deprecating connotations of the term “dai” have not looked carefully into the history of the dai’s role in South Asian societies and the extent to which colonial representations of the dai and the very process of the professionalization of obstetrics in South Asia may have significantly transformed these women’s status. Patricia Jeffery et al. refer briefly to the possibility of a historically shifting status of dais when they write:
The few historical sources that feature dais and women’s experiences of childbearing are often written by doctors patently biased against their competitors. Thus we cannot be sure about how dais’ skills and status might have changed, especially in the wake of the major secular changes since the mid-60s. Possibly in the face of what are probably more restricted employment opportunities for women in the poorest classes, proportionately more women are being pauperized and more women with families without traditions of dai practice may be resorting to an occupation that is becoming increasingly de-skilled. Further, as urban medical facilities have expanded, any ante-natal, abortion, and infertility work of dais may have declined, and dais may have become more restricted to delivery work.13
Yet Jeffery et al. do not pursue this line of thinking further. Such historical contextualization is critical for a more complete understanding of the dai’s role in India and the role of the so-called TBAs in any society. This chapter will emphasize colonial representations of dais and of local childbirth practices in the contexts of attempts to professionalize obstetrics in India and of the colonial civilizing process more generally.
The historical vilification of midwives in Europe and America has been well documented.14 In Europe female healers were accused of witchcraft by the emergent elite male biomedical establishment as early as the thirteenth century, when medicine was becoming a secular science and profession. By the seventeenth and eighteenth centuries, midwives were singled out as a danger to society.15 This clearly had an impact on colonial representations of dais in South Asia, and such negative representations continue to stigmatize dais in India today. Recently, some scholars have attempted to excavate the history of the social and cultural significance of dais in India, highlighting both their authority as ritual specialists and their expertise in many areas of the physical management of birth.16
Anthropologists working in other areas of the world have discovered that prior to colonial contact and the concomitant spread of biomedicine, lay midwives often garnered a great deal of respect and held positions of political authority. This was apparently the case for the nanas in Jamaica and members of the Sande society, who traditionally provided maternal and child health care, in Sierra Leone.17 We should not, however, assume that in precolonial India lay midwives must have held similar positions of respect. To do so would be to fall into the trap of romanticizing about the “traditional other.” Indeed, it may well be that in the precolonial era lay midwives in many parts of South Asia were viewed as unskilled, menial, and “polluted” members of society, as they are often considered today.18 Both assertions need to be investigated rather than assumed. The problem is, of course, that this is an extremely difficult history to recover.
During the late nineteenth century, colonial administrators, missionaries, and medical professionals began to lump a variety of traditional midwives together under the term “dai,” applying it to midwives throughout colonial India (including contemporary Bangladesh and Pakistan) and to midwives of different religious communities. Stacey Pigg has pointed out that in contemporary international development projects undertaken in Nepal, the term “traditional birth attendant” is similarly used as a homogenizing gloss for a wide variety of local healers.After this category of TBA had been created, the Nepali word chosen to translate the category was sudeni, which originally referred to only one kind of healer involved in childbirth. Consequently, the word “sudeni” itself has come to have new meaning in Nepali society.19 An important and difficult task for historians of South Asia is, therefore, to begin to tease apart the regional and religious differences in the roles and representations of midwives prior to the colonial encounter. Remnants of these differences still exist today and must be studied more carefully by anthropologists and other social scientists.
In Tamil Nadu, for example, a hereditary Hindu midwife is most commonly referred to as a maruttuvacci, and a hereditary Muslim midwife is usually called a nācuvar or an ampa