Birth on the Threshold: Childbirth and Modernity in South India (2008)

REVIEW OF BIRTH ON THE THRESHOLD: CHILDBIRTH AND MODERNITY IN SOUTH INDIA BY CECILIA VAN HOLLEN. BERKELEY, CA. UNIVERSITY OF CALIFORNIA PRESS, 2003. In her book Birth on the Threshold, Cecilia Van Hollen describes the modernization of childbirth among poor women of Southern India. The author begins the book with the birth story of Mumtaz, Tamil Nadu woman who delivered her baby right in the doorway (vacal) of the house. The author elucidates the importance of the doorway as the threshold between the private (home) and public (the world) space as metaphor shift from one institutional site (i.e., the family and the midwife) to another institutional site (i.e., the public hospital as site of both the state and biomedicine) and a shift in systems of knowledge about the body in general and women's reproductive bodies in particular (p. 3). In the book's Introduction, Van Hollen describes Tamil women adorning this sacred space with intricate geometric designs made of rice flour called kolams which bring blessing to all who pass through the threshold. She artistically uses the metaphor of kolams to describe the individual processes of change that loop and swirl to pull together the transformation and modernization of childbirth in Southern India (p. 6). Although Van Hollen rarely compares the Southern Indian cultural experiences to those of Western cultures, in Chapter 1, The Professionalization of Obstetrics, she enlightens the reader on the colonial history of obstetrics in India via cultural and gender variations. Obstetrics had long been female dominated field in India due to cultural taboos that did not allow women to be seen by male doctors. This push also came from disdain midwives (dais) who had always been responsible non-institutionalized births. Van Hollen describes the hierarchy of midwives and reveals the low class status of the profession and how they are thought to clean the pollution of birth. In Chapter 2, Maternal and Child Health Services in the Postcolonial Era, Van Hollen thoroughly describes the postcolonial structures of maternal and child health (MCH) services in both rural and urban Tamil Nadu from social, familial and institutional perspective. She found that in urban Madras, most women give birth in hospital setting whereas in the rural Kaanathur-Reddikappam region, about half of the women chose to give birth at home. Throughout the book, Van Hollen skillfully interweaves Tamil women's stories together to describe the childbirth experience from pregnancy through the postpartum period. In Chapter 3, Bangles of Neem, Bangles of Gold, she beautifully describes cimantam (the ritual celebration of first pregnancy) and pregnant women as auspicious burdens (p.77). She describes the reinvention of the cimantam tradition from ritual of preparation woman's first birth, to more consumer centered celebration where the mother-in-law is portrayed as materialistic and greedy. It is in this section of the book that the author meticulously describes the concepts of acai (a combination of food cravings, an increase in 'heat,' the demands of the fetus (cul), and desire to return to the maternal home to be cared for (p.87)) and sakti (divine female power associated with actions and the generative force of the universe (p. 240). In relation to pregnancy, when woman's acai, is met (she is given gifts of bangles or gold), this gives her sakti. If she has sakti, she will have positive delivery experience and healthy baby. In Chapter 4, Invoking Vali, the author describes how rather than decreasing the pain of childbirth by use of analgesic drugs as in western cultures, women of Tamil Nadu have come to expect an acceleration of the experience using oxytocin drugs such as pitocin. To Tamil women, prolonged labor connotes danger to the mother and the baby. In addition, Van Hollen describes the concept of invoking vali: pain or suffering. …