Lifespan Development. Tara L. Kuther

      A midwife prepares a mother to give birth in her home. Birth practices vary by culture.

      Stephanie Maze/Corbis

      Societies vary in their customs and perceptions of childbirth, including the privacy afforded to giving birth and how newborns are integrated into the community. In the United States, birth is a private event that usually occurs in a hospital, attended by medical personnel and one or two family members. In most cases, the first-time mother has never witnessed a birth but is well educated and may have well-informed expectations. After birth, the mother and infant are often visited by family within designated hospital visiting hours; the newborn usually rooms with the mother all or part of the day.

      In a small village in southern Italy, birth is a community event. It usually takes place in a hospital, attended by a midwife (Fogel, 2007; Schreiber, 1977). Just after birth, the midwife brings the mother’s entire family (immediate and extended) to the mother’s room and they take turns congratulating the mother and baby, kissing them. The family provides a party, including pastry and liqueurs. During labor and afterward, the mother is supported and visited by many of her friends and relatives to recognize the contribution that the mother has made to the community. The mother-in-law is an example of the social support system in place because a few days before and until about 1 month after the birth, she brings and feeds the mother ritual foods of broth, marsala, and fresh cheeses (Fogel, 2007; Schreiber, 1977).

      In some other cultures, birth is an even more public process. The Jahara of South America give birth under a shelter in full view of everyone in the village (Fogel, 2007). On the Indonesian island of Bali, it is assumed that the husband, children, and other family will want to be present. The birth occurs in the home with the aid of a midwife and female relatives. As a result, Balinese women know what to expect in giving birth to their first child because they have been present at many births (Diener, 2000). The baby is immediately integrated into the family and community as he or she is considered a reincarnated soul of an ancestor. Many kin are present to support the mother and baby since the child is considered to be related to many more people than its parents.

      Childbirth is tied to social status in the Brong-Ahafo Region in Ghana. After a delivery, women achieve a higher social position and can then give advice to other women (Jansen, 2006). Home deliveries are highly valued. The more difficult the delivery and the less skilled assistance she receives, the more respect a woman attains, the higher her position will be, and the more influence she has on the childbirth decisions of other women, such as whether to give birth at home or in a medical setting and how to combine traditional and modern practices (Bazzano, Kirkwood, Tawiah-Agyemang, Owusu-Agyei, & Adongo, 2008).

      Many cultures conduct rites that they believe protect newborns from evil and spirits. Among the Maya of the Yucatan region of Mexico, there are few changes in the expectant mother’s surroundings; the Mayan woman lies in the same hammock in which she sleeps each night. The father-to-be is expected to be present during labor and birth to take an active role but also to witness the suffering that accompanies labor. If the father is not present and the child is stillborn, it is blamed on the father’s absence. The pregnant woman’s mother is present, often in the company of other females, including sisters, sisters-in-law, mothers-in-law, godmothers, and sometimes neighbors and close friends. The mother and child must remain inside the house for 1 week before returning to normal activity after birth because it is believed that the mother and newborn are susceptible to the influence of evil spirits from the bush (Gardiner & Kosmitzki, 2018).

      A neighboring ethnic group, the Zinacanteco, place their newborns naked before a fire. The midwife who assisted the mother says prayers asking the gods to look kindly upon the infant. The infant is dressed in a long skirt made of heavy fabric extending beyond the feet; this garment is to be worn throughout the first year. The newborn is then wrapped in several layers of blankets, even covering the face, to protect against losing parts of the soul. These traditional practices are believed to protect the infant from illnesses as well as evil spirits (Brazelton, 1977; Fogel, 2007).

      What Do You Think?

      1 Which of these birthing customs most appeals to you? Why?

      2 If you, a family member, or friend have given birth, describe the process. Where did the birth occur? Who witnessed it? What happened afterward? When did family and friends meet the baby?

      Natural Childbirth

      Natural childbirth is an approach to birth that reduces pain through the use of breathing and relaxation exercises. Natural childbirth methods emphasize preparation by educating mothers and their partners about childbirth, helping them to reduce their fear, and teaching them pain management techniques. Although most women use at least some medication in childbirth, many women adopt some natural childbirth methods.

      The most widely known natural childbirth method—the Lamaze method—was created by a French obstetrician, Ferdinand Lamaze (1956). The Lamaze method entails teaching pregnant women about their bodies, including detailed anatomical information, with the intent of reducing anxiety and fear. When women know what to expect and learn a breathing technique to help them relax, they are better able to manage the pain of childbirth. The Lamaze method relies on the spouse or partner as coach, providing physical and emotional support and reminding her to use the breathing techniques.

      In addition to the expectant mother’s partner, a doula can be an important source of support. A doula is a caregiver who provides support to an expectant mother and her partner throughout the birth process (Kang, 2014). Doulas provide education about anatomy, delivery, and pain management practices, such as breathing. The doula is present during birth, whether at a hospital or other setting, and helps the woman carry out her birth plans. The presence of a doula is associated with less pain medication, fewer cesarean deliveries, and higher rates of satisfaction in new mothers (Gabbe et al., 2016; Kozhimannil et al., 2016).

      Home Birth

      Although common in nonindustrialized nations, home birth is rare, comprising 1.5% of all births in 2016 in the United States (MacDorman & Declercq, 2016). The remaining 98% of births occur in hospitals. Most home births are managed by a midwife, a health care professional, usually a nurse, who specializes in childbirth. Midwives provide health care throughout pregnancy and supervise home births. One review of 50 studies found that the use of midwives, whether as part of a home birthing plan or as part of a plan to birth in a hospital setting, is associated with reduced neonatal mortality, reduced preterm birth, fewer interventions, and more efficient use of medical resources (Renfrew et al., 2014).

      Is a home birth safe? A healthy woman, who has received prenatal care and is not carrying twins, is unlikely to encounter problems requiring intervention—and may be a good candidate for a home birth (Wilbur, Little, & Szymanski, 2015). Although unpredictable events can occur and immediate access to medical facilities can improve outcomes, studies from Europe indicate that home birth is not associated with greater risk of perinatal mortality. However, home birth is far more common in many European countries than the United States (20% in the Netherlands, 8% in the United Kingdom, and about 1% in the United States) (Brocklehurst et al., 2011; de Jonge et al., 2015). The few U.S. studies that have examined planned home birth compared with hospital birth have found no difference in neonatal deaths or Apgar scores, and women who have a planned home birth report high rates of satisfaction (Jouhki, Suominen, & Åstedt-Kurki, 2017; Zielinski, Ackerson, & Kane Low, 2015). Cultures vary in their approach to birth, as discussed in the Cultural Influences on Development feature.

      Thinking in Context 3.3

      1 Given what you know, create a birth plan for a healthy woman in her 20s. Would you choose a hospital or home birth? Why? How would your plan address the expectant mother’s need for pain relief?

      2 If possible, ask adults of different generations, perhaps a parent or an aunt and a grandparent or family friend, about their birth experiences. How