She estimates her age to be 72, although no record of her birth exists. She has only a few gray hairs on her head and her face is noticeably free of wrinkles, despite a lifetime of hard work. In her village Danyanish Mekonnen, mother of five grown children, holds the respected title of awaledje. Awaledje is the Amharic word for traditional birth attendant, a woman who, without any formal training, assists other women in giving birth. In nearly every village one woman stands out among the rest as the awaledje and is seen as an authority on childbirth and infant care. I had the opportunity to talk with Danyanish during a recent trip to Ethiopia.

This was my second trip to Ethiopia, the birthplace of my husband. Getting to his village was quite a journey–a long bus ride over pothole-filled roads, an hour-long walk under the hot sun and a nerve-racking scamper over a precarious foot bridge that spanned a roaring river. I met Danyanish, my husband’s aunt, when she came to the village to celebrate our arrival. She stayed with us for several days, which allowed me the perfect opportunity to talk with her, ask questions and learn. Since she doesn’t speak English and I am not fluent in Amharic, we couldn’t speak directly to each other. I asked my husband’s younger brother, Teferi, to translate for us and one morning as we sat with the other older women of the village on cowskins laid out on the ground in the shade of the family hut, I began my interview. We talked about pregnancy, birth, female circumcision, raising children, and sex. Each question I asked was the source of much discussion among the women. Finally, as each discussion died down, Danyanish would give an answer to Teferi and he would attempt to translate it for me. It was a long process and there’s no telling how accurate all of us were. Because the secrets of childbirth are never shared with men in Ethiopia, Teferi got an education that morning that most men in Ethiopia will never get.

At the age of 15, before having given birth herself, Danyanish began to learn about childbirth from a female slave of her husband’s family. She started by helping the woman and eventually took over as the birth attendant for all the members of her family. Danyanish never went to school or had any formal training. She learned everything from experience and from the stories of the women around her. When I tried to ask Danyanish why she was drawn to this type of work the question had no meaning to her. She could only say was this is what God intended her to do.

Traditionally, when labor starts, the birthing woman will go to the house of her mother. When she arrives at her mother’s village, all the men leave the family hut and the women of the village gather to provide support and encouragement. By the time most women give birth themselves, they have already witnessed the births of siblings, cousins and other children of the village. Childbirth is not hidden from them as it is in many other cultures so most women go into labor without fear. The women of the village stay with the birthing woman throughout her labor, with one woman always near her head and one behind her to support her and hold her up. When the awaledje arrives she brings her only tools: a razor blade, some string and the leaves of the castor bean plant. The women sing and tell stories and stay with the birthing woman for as long as the labor lasts. Children come in and out of the hut but no male child over the age of seven is allowed in.

As in every culture, the people of Ethiopia have their own particular ideas and beliefs about childbirth. Here, birth ritual is steeped in the Christian religion. Most Ethiopians belong to the Coptic Church, which is believed to be the oldest Christian sect in the world. In their belief system, the Virgin Mary, or Miriam as they call her, oversees and protects the birth process. When a pregnant woman prays for the protection of her baby, she prays to Miriam. When she is in labor and prays for relief from the pain, she prays to Miriam. The castor bean leaf used in labor is also connected to Miriam Miriam was believed to have used the leaves of the castor bean to cover herself when she journeyed to the place where she gave birth.

As the labor progresses and the pains become more difficult, women of the village pray and chant to Miriam to help the birthing woman cope. Sometimes, when a labor is very long and difficult the women of the village will put huge rocks on their shoulders and walk around the hut trying to take some of the burden of the mother’s pain and to encourage her to keep going.

When the baby arrives the birth attendant will catch the baby in the castor bean leaves. She will measure four fingers width on the cord then tie string on both sides and use a razor blade to cut it. Another castor bean leaf is used to push on the genitals to protect the uterus from �coming out.� When the time comes to birth the placenta the women dig a hole in the floor of the hut and the new mother squats and births the placenta in the hole where it will be buried. If the woman’s perineum tears, the awaledge will wash the area with warm water then paint the perineum with clarified butter every day for one or two weeks.

The postpartum period lasts a long time for Ethiopian women. The new mother stays in the hut, mostly in bed, for 40 days. She is considered unclean and cannot enter a church during that 40-day period. She will not cook any food or perform any of her normal duties in the village. Her mother or another woman of the village will prepare a special dish for her which is believed to have special healing properties for a postpartum woman. The dish is a type of porridge made from roasted, crushed barley and topped with spiced clarified butter. She will also drink diluted tella, a homemade beer.

After she gives birth the woman will not be left alone with her baby for 10 days. Ethiopian believe that during this time the new mother is more likely to become crazy or possessed and may harm herself or the baby. To prevent harm, either another woman or a child will always be with her. Soon after the birth a priest from the closest church will come and bless the baby and sprinkle holy water on any family member who has touched the woman. Since she is “unclean� during those 40 days the holy water is meant to protect anyone who has had contact with the mother.

In a country like Ethiopia where the infant mortality rate is reported to be 120 per 1000 live births (compare to 4 per 1000 in the U.S.), and where there are is only one trained doctor for every 32,000 people (compare to 1 doctor for every 400 people in the U.S.), the possibility of death for mother or baby during childbirth is a concern for every family. If the mother dies during childbirth, the baby will be forced to swallow fresh butter until another family member can breastfeed the baby. If the family has no lactating women the awaledge will see to it that one of the women of the village will agree to feed the baby.

Danyanish explained that if a woman has given birth, no matter how long ago, she is able to lactate again if she collects ash from the fire, filters the ash and adds water and drinks the mixture. “How can this be true?� I thought. But as I asked around, woman after woman not only told me it was true but recounted numerous examples of when this had happened.

As I started to wind down my questions, the group of women turned the tables and began to question me. They wanted me to tell them about childbirth in America. Everything I tried to explain sounded so ridiculous when I said it out loud. How could I explain an electronic fetal monitor to someone who has never even seen a computer or a water birth tub to someone who has never seen a swimming pool? A lot can be lost in translation when you attempt to explain vacuum extraction, forceps or pitocin.

While in the U.S. we have medicalized birth to the point of absurdity, here in a small pocket of the country, a place called Bellingham, Washington, we have choices that women in Ethiopia could not even dream of. We can choose from hospital, home or birth center. We can choose a doctor or midwife. We can have our friends and family present or we can choose to be alone with our partners. We can choose to take childbirth classes, read books about labor and watch birth videos. We can choose to use birth balls, water birth tubs and doulas. But whatever we choose, like the women in Ethiopia, we need to believe in ourselves and our amazing ability to give life.

Deborah Craig lives in Bellingham, Wa. with her partner, Negash and their two children, Makela and Mario. She teaches natural childbirth classes and enjoys collecting stories of birth rituals from around the world.

Copyright © 2005 Midwifery Today, Inc. All rights reserved.
Reprinted with permission from Midwifery Today, Number 75.
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