Navajo childbirth in transition.

This paper is a review of the available literature concerning the changes in Navajo childbearing practices, and comparable changes in childbearing practices in the dominant American society. It reviews factors that permitted the acceptance of biomedical childbirth by Navajo women and explores the health implications of the transition. In the past, a complex of ritual beliefs and proscriptions led to a traditional way of giving birth that integrated both the mother and the infant into the cultural and religious fabric of Navajo society. The roots of this birthing system stem from a general belief system which prescribes one's relationship with their ritual, spiritual, and cultural world. The taboos which surround the activities of daily life, including childbirthing, are designed to protect the individual from falling into disharmony with nature. Harmony with nature is the root of all that is good in life, and it is the objective of the major Navajo ceremony that places the recipients in tune with the Holy People who created humankind the Blessingway. Birthing normally occurred in the home or outside in the summer shelter. Modern medical practices have been available to some Navajo people since the first few physicians arrived in 1880. However, widespread acceptance of modern medicine did not begin to occur until after the Second World War, when many Navajos served in the armed forces and became convinced of the efficacy of Western medicine. Since the 1950's, several factors have made the biomedical approach to pregnancy more acceptable to Navajo women. The first was a marked reduction in the physical and cultural isolation of the Navajo Reservation. Then hospital delivery held the promise of safer, more comfortable childbirth. Hospitals ceased being perceived as places where one goes to die, and women were drawn to the opportunity to receive pain medication during labor. A third factor was the fact that it became harder for young women to learn the rituals of childbirth at home. Boarding schools separated Navajo children from the sources of traditional knowledge. The practitioners of traditional healing began to decline in number, and the Navajo healing tradition began to tolerate the concomitant use of Western medicine. Also, those caring for Navajo people made efforts to provide medical care that was culturally acceptable. The author concludes by saying that in the transition from traditional childbearing practices to modern biomedical practices, there have been gains as well as losses. One source of stress and dissatisfaction is the loss of control over the birthing process with the relocation of childbirth into the hospital. However, the improvement in the maternal and perinatal morbidity and mortality has been remarkable. Prenatal diagnosis and treatment of maternal conditions, prevention and treatment of puerperal sepsis, safety of operative deliveries, and improved survival of sick and premature newborns are all largely the products of medical technology. As Navajo society changes, the admixture of traditional beliefs and practices with those of biomedicine appears to be providing the internal consistency needed to serve the majority of Navajo women quite well.