Women in Western countries have been struggling for several decades against what is now widely viewed as the unnecessary and excessive medicalization of childbirth. The move to a less interventionist model for childbirth has been a genuine gain for many women in the West (see Martin 1987; Oakley 1986), but there is a real risk of mythologizing and romanticizing the process of ‘natural childbirth’ and of projecting this image on to a Third World context where it is not always appropriate.

World Health Organization (WHO) policy for some years has emphasized working through traditional birth attendants (TBAs) as the best path to improving the appalling level of maternal and child mortality and illness in much of the Third World (see pp. 166–7 below). Recently, some doubts as to the universal appropriateness of this strategy have begun to surface (e.g. Scheepers 1991 for Yemen; Stephens 1992 for Andhra Pradesh). My own material on childbirth in rural Bangladesh suggests that we need to examine the concept of the TBA in more critical detail. It is too easy, perhaps, to counterpose the midwife to the doctor, seeing the former as a repository of traditional wisdom and the latter as a projection of patriarchal intervention. In practice, both may have serious deficiencies in terms of delivering effective health care, and their effectiveness may be further compromised by the cultural and material situation within which they work. In this chapter we will see that neither the village midwife (the dai) nor the village doctor are really in a position to care effectively for birthing women.