Traditional obstetrics in Isaan, Thailand
Durham, United Kingdom
|Fig 1. The house in which I was born. Births were in a living room, far left. The natal hearth was under the roofed veranda. Sketch by author, ©. May be reproduced for non-commercial purpose|
Traditional midwifery and the culture of birth in Isaan, Northeast Thailand, may hold lessons for the prevention of obstetric complications. Since traditional midwifery has been declining for the past two decades,1,2 in 2020 I interviewed elders in my home village in the Yang Talat district in order to preserve their rapidly disappearing knowledge.
Pregnancy was traditionally diagnosed by the cessation of menstruation and symptoms of morning sickness, rather than with medical testing. Isaan women usually work in the fields until they go into labor. The culture believes in hard, physical work, and that without regular activity births are more difficult. My midwife was called mère yai (grandmother) Poi, a village elder who did antenatal examinations of uterine size and fetal head position. This title of respect reflected her experience. A midwife would make two or three home visits during the course of a pregnancy and would also do the delivery. Until recently, state-sponsored health education visitors complemented traditional midwifery care.
Early in the pregnancy, the father collected green tree branches for a natal fire. This could not be dead wood, but needed to be cut green and seasoned for quality and to minimize smoke. The purpose of this fire was to boil water for washing, for drinking, and to create a maternal infusion drink. The fire also warmed the mother after delivery. Towards the end of the pregnancy, families would make a hearth (Fig 2) out of a hardwood such as mahogany. The hearth was built in the shape of a square or rectangle with box sides, was about one meter square, and was safe to use on a teak floor. A base of insulating banana trunks, which hold a lot of fluid, was placed on top of the wooden base and coated with clay. Once the fire was ablaze above, this formed a ceramic layer. My own hearth was well-made with dove-tailed joints and was lent out to other families.
|Fig 2. Cross-section of natal hearth, some clay removed to show whole and half banana trunks, with trumpet-neck vessel for bamboo infusion and hot water cauldron. Sketch by author, ©. May be reproduced for non-commercial purpose|
Rice husk was never burned in the natal fire, as it has a notorious local reputation for causing neonatal sickness and death in humans, dogs, and cattle, as well as stopping maternal milk production. Village etiquette dictates that this husk is not burned around a new mother and baby. This traditional wisdom has been substantiated by modern evidence of phenol and furfural chemicals generated in husk smoke.3 Phenols lower blood pressure4 and could potentially contribute to deaths, especially if blood pressure is already low from perinatal blood loss. Hormone blocking effects may interfere with milk production. Phenol exposure in infants may trigger asthma, impede future fertility,5,6 and affect skeletal health.7 Furfural is a known carcinogen and reduces respiratory effort.8
A birth in the village generated much social excitement. Men congregated in their own area of the house and prepared the hot water in a large hanging cauldron. A separate trumpet-neck vessel brewed the infusion over laterite stones around a charcoal fire with tongs under the neck flair. Similar vessels have been found in 2000-year-old Isaan burial sites. The infusion was created from dried bamboo roots and shoots, Cassumunar ginger (wan feye), dark sugar cane, tamarind trunk core, and Bauhinia strychnifolia (ya nang derng).
Tamarind is believed to encourage milk production, is reported to be anti-inflammatory, and is used to enhance wound healing in Africa9 and India.10 Cassumunar is antibacterial11 and anti-inflammatory.12 Bamboo contains chemicals which are antioxidant, anti-inflammatory, and may have hormonal effects.13 Bauhinia is antibacterial and antifungal.14 These plants were gathered, washed, and chopped by the father or grandfather and added to the pot each day. The father would also make a bamboo basket crib for the baby, with a low rim of about 1.5 inches.
A cloth was twisted into a rope and suspended from a ceiling beam to aid the mother in pushing. (Fig 3) Every household kept this type of cloth, which is longer than the usual woven cotton lengths used for clothing and cut to size to be comfortable for the mother to hold. After the birth, someone was chosen to cut the umbilical cord, usually a friend or relative of good character. The belief is that they would pass on their good character to the baby. My uncle, a successful joiner, cut the cord at my birth and says that he crafted the wisdom within me. The umbilical knife is a very sharp sliver of freshly-cut bamboo rind, which is also known to have natural antibiotic properties.13
|Fig 3. Isaan birth typical of the 1970’s, the mother straining on a pendant cloth. Source. Reproduced with the kind written permission of Mr. Yuthpichai Jamnoiprom.|
The baby was washed in warm water by hand on the lap of the grandmother or a helper sitting on the floor, and then dried, wrapped, and sent out to another helper. Layers of soft cloth, usually locally-woven cotton, were used to wrap the baby, including the head, but not tightly. It was then customary for a grandmother to chant, holding a knife to ward off evil spirits: “We have this baby now to care for and protect. Do not come near this baby.” Warding off evil spirits at a birth is an ancient belief that predates Hinduism and Buddhism. The mother was encouraged to walk soon after delivery in order to wash on the balcony with warm water and no soap, with one or two helpers assisting her.
Soon after the birth, the mother began drinking the infusion. (Fig 4) Her abdomen was kept near the fire with the midwife adjusting her position. Families planned to have babies at particular times of the year, especially avoiding the heat of high summer. My birth in May occurred during a cooler time of year when it rains.
Mother and baby remained close to the fire for a week or more, with the baby well away from the hearth. (Fig 4) Keeping a mother warm may alter blood flow, accelerate healing, and reduce bleeding risk. There is no scientific work on this, but such a strong and detailed tradition suggests that this was not just a matter of comfort. There is evidence that warm showers reduce a woman’s fatigue after delivery.15
A grandmother, sister, or close friend brought the baby to breastfeed from the basket or hammock where he slept. The help of family and friends continued for seven to ten days. Sometimes mothers shared breast milk with young children whose mothers had difficulty producing their own. My mother told me there were two or three children in the village who shared her milk with me. These children would bring a coconut or silver bowl to collect milk and sit next to me every day for months.
The placenta was traditionally buried at the foot of the house ladder. This idea also has very early origins that predate Hinduism and the later Buddhism. While placenta burial still occurred when I was young, the reasoning behind it had faded. Umbilical fragments were kept in the spirit house shrine to the genius loci (spirit of the place). Isaan was settled during the late Bronze Age, implying that these ideas migrated to the region from elsewhere. In Isaan, old religion never disappears, but beliefs tend to pile up on top of one another.
|Fig 4. Mother with helpers, drinking the infusion next to the fire. Source. Reproduced with the kind written permission of Mr. Yuthpichai Jamnoiprom.|
Helpers tended to the natal fire every day and served the post-natal infusion drink. For colic in the baby, Cassumunar ginger was applied as a tummy rub. If a baby had a cold, they would sleep with a cloth parcel of shallot onions.
After the birth, men celebrated with lao kao rice liqueur. When I was born, the midwife also partook and was wheeled out in a wheelbarrow. It was not clear when she went off duty. The role of women at a traditional birth in Isaan illustrates an important point: they were afforded great respect. Even today, different women in the village are noted for particular skills, including cotton weaving, pillow making, cooking expert recipes, basket mat weaving, and even where and how to catch scorpions for the grill. Women have never been excluded as outsiders. Men make the basket-woven rice pots—gadip kao—because bamboo cutting requires extra strength for knife control. It is easy to slice the ends of fingers off with the Isaan knife or bamboo strips. I have never known a woman to cut bamboo for anything, including making the umbilical knife. Anyone is welcome to try, but I personally am happy to delegate that task and keep my fingers.
Babies were weaned on rice which the mother chewed, mixed with her own milk and some banana, then grilled in banana leaves. There may be some immunity conferred to the infant from maternal saliva exposure.
Natal fires are still used very occasionally, but, in recent years, nearly all births occur in the hospital. Traditional midwives have now vanished, like many other customs. There was no electricity in the village when I was born in the 1970s. Although my grandfather, Thao Bhunmi, was the Headman, his only distinguishing luxuries were radio and Ovaltine. Now every family has a plasma screen, a car, a pick-up truck, and iPhones. Most working-age adults live in Bangkok. We must record our traditional customs so that they are not forgotten and we can study the ancient wisdom within them.
I could not have written this without the keen interest in Isaan traditions of our village elders, including Budrien Phupanphet, Prathoeng and Saithong Phusrisom, and Abbott Luang Por Kiao, amongst others. All were delighted to share their knowledge, experiences, and love of Isaan in lengthy, structured interviews specifically for this paper. Thanks to Professor Stephen Martin of the Royal Asiatic Society for his advice.
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KHWAN PHUSRISOM, BSc, FRAS, FRSA, Commander of the Order of the Crown of Thailand, graduated with a BSc degree from Chandrakasem University, Bangkok. She lives between Thailand and England and is a Fellow of the Royal Society of Arts, UK, and a Fellow of the Royal Asiatic Society of Great Britain and Ireland.
Highlighted in Frontispiece Volume 13, Issue 1 – Winter 2021
Summer 2020 | Sections | Birth, Pregnancy, & Obstetrics