Discussion and conclusion
The findings reported in this study were based on
qualitative research that focuses on meanings and
interpretations of individual women. Qualitative
research provides a sophisticated research strategy
to understand how, and why, people act in
particular ways (Liamputtong and Ezzy, 2005).
However, the findings generated from a qualitative
method cannot be generalised across the whole
population. According to Sarantakos (1994), ‘the
sample units are typically representative of a group
of phenomena, (p. 15). In this study, it was a group
of Thai women in northern Thailand and their
traditional beliefs and practices of pregnancy and
childbirth. Data generated from our qualitative
approach provide readers with a deeper understanding
of the women’s subjective experiences of
childbirth, as the information was gained through
their own voices.
According to Laderman (1984), ‘childbirth is
the most significant of all rites of passage,
conferring new status of the parents and changing
a non-entity, the unknown fetus in the womb, into
an individual with kinship ties, functions and
potentialities within a society’ (p.549). Although
conception occurs within a woman’s body (her
womb), pregnancy is given ‘meaning by the
dialogue between empirical perceptions and a
system of symbols that takes place in every culture.
They are elaborated on and accompanied by
behavioural changes that define the roles of the
actors and are intended to protect those who, by
virtue of their liminality, are especially vulnerable
to harm’ref. In this sense, both mothers and their
fetuses or babies are vulnerable entities that need
to be protected by rituals.
Women’s explanations discussed in this paper
point to the need to see pregnancy as a rite of
passage as proposed by van Gennep (1960). Childbirth
in many societies is seen as dangerous,
powerful or polluting (Kitzinger, 1978). A woman
is not yet a mother, yet she is clearly different from
the state before her pregnancy. It is a time when
the woman is in ‘a liminal state, separate from the
safe categories of ordinary existence’ (Homans,
1982, p. 25). This liminal state is referred to as
‘rites of passage’ (van Gennep, 1960). The theory
offers illuminating patterns of childbirth in many
traditional societies.
In rites of passage, people are separated from
ordinary society. This can be seen clearly with
women in childbirth. In most societies, parturient
women are usually separated from normal social
activities. However, in most cases, the separation is
not physical but behavioural and in terms of diet.
This is an attempt to safeguard the woman from
danger as well as to protect others around her from
her ‘liminal and polluted state’ of health. We argue
that this may also hold true with Thai childbearing.
Pregnancy is seen as a transitional state when a
pregnant woman is not yet a mother but is clearly
different from other women. Her behaviour and
diet are set apart from those in everyday life and
from other members of the society. These behavioural
and dietary distinctions function to protect
her from danger, giving her the best possible
chance to carry her pregnancy to term.
In discussing childbirth among Malay women,
Laderman (1987) argues that childbirth is ‘not only
a physiological event’ (p.124), but also ‘a stage in a
rite of passage requiring spiritual prophylaxis and
ritual expertise’ (p.124). This is similar to the Thai
view of birth. In a normal birth, a woman separates
from others by retreating into her bedroom and
giving birth with a minimum of assistance. However,
in certain circumstances, such as a long and
difficult labour, a woman may require physical
support and spiritual and ritual aid from traditional
healers, and there are people around her who
can help.
In most traditional societies, a labouring woman
is usually assisted by other women or birth
attendants (Sargent, 1982; Goldsmith, 1990). Thai
traditional childbirth is similar. Goldsmith (1990)
points out that, in most traditional societies,
women do not give birth among strangers. Women
carry out their ‘intimate act’ (p.25) among those
whom they ‘know well and trust’ (p.25). Most
often, women give birth with the assistance of their
mothers-in-law and their husbands. Even the
healers who are called in when complications occur
are those whom the women know. Goldsmith (1990)
argues that familiarity with the people around her
helps a woman in traditional societies to have ‘a
positive attitude toward the birth process’ (p. 97).
This argument may also be applicable to Thai
women who give birth among those whom they
know well and trust. Although birth is seen as a
woman’s affair, it is also related to the family, the
community, the society and the supernatural world.
This can clearly be seen in the case of a difficult
birth, with the healing processes involving many
people and supernatural beings. These ‘helpers’
relieve the woman’s difficulties in bringing another
life into society. It is clear that the social meanings
of birth in Thai culture are part of a larger social
system that involves the woman, her family, the
community, society and the supernatural world, as
Lefkarites (1992) points out:
Childbirth is a significant human experience, its
social meaning shaped by culture in which
birthing women live. Cultures throughout the
world express the meaning of childbirth through
different beliefs, customs and practices. These
diverse cultural interpretations are part of a
larger integrated system of beliefs concerning
men, women, family, community, nature, religion,
and supernatural powers (p.385).
In the old days, traditional midwives played a
vital role in pregnancy and birth in Thai society(Anuman Rajadhon, 1987; Jirojwong, 1996; Whittaker,
2000, 2002). A traditional midwife does
‘more than just deliver babies. As part of the local
community, she is acquainted with the woman and
her family with whom she shares the cultural ideas
about how the birth has to be prepared for and
performed. She knows the local medicines and
rituals that are used before, during and after birth.
The work of the traditional midwife is adapted and
bound to the social and cultural matrix to which she
belongs, her beliefs and practices being in accordance
with the needs of the local community’
(Lefeber and Voohoever, 1997, p. 1175). Despite
this, the number of traditional midwives has
reduced dramatically in Thailand.
Traditional beliefs and practices in Thai culture
clearly aim to preserve the life and well-being of a
new mother and her baby. This is similar to the
biomedical model of childbirth. But, as we have
shown in this paper, the two systems may, as
Muecke (1976) argues, ‘differ in terms of both the
immediate social context in which they act, and of
the cultural values that they espouse’ (p.377). In
Thai culture, pregnancy and birth are treated as
part of a childbearing process that is a normalevent in a woman’s life. Despite this, pregnancy
and birth can be a critical event that may ‘imperil
her well-being’ (Laderman, 1987, p. 172) and, in
some cases, may end with the death of the woman,
her newborn baby, or both. The Thai have
established certain beliefs and practices to prevent
this and to assist women who have difficulties
giving birth, as have been discussed throughout
this paper.
It seems that traditional childbirth practices
have not totally disappeared in northern Thailand,
but they have gradually diminished. Why has this
happened? Birth in Thailand has been medicalised,
hence, its management is controlled by doctors and
nurses, and it takes place in hospital settings. The
medicalisation of childbirth in Thailand health
care, like childbirth in many Western societies,
makes medical knowledge ‘supersede’ other kinds
of relevant sources of knowledge, such as cultural
beliefs and practices. As such, traditions may no
longer be relevant, or at worse, must be relinquished.
Cultural knowledge has become structurally
inferior to Western biomedicine (Lee, 1982).
In addition, modernisation of society may also
contribute to this. This results in the neglect of
many traditional practices of pregnancy and birth
in hospitals. Muecke (1976) argues that ‘the underpinnings
of this rapid change have, as part of the
processes of ‘modernisation’, ‘westernisation’ and‘urbanisation’, been discussed in terms of the
socioeconomic and political development of thecountryy. Such aspects of ‘modernisation’ have
made a social context that is often incompatible
with the socialising messages and cultural attitudes
of the North Thai health-care system, and therefore
are no doubt contributing to its demise’
(p.380).
Women’s social backgrounds influence traditional
beliefs and practices (Lazarus 1994; Zadoroznyj,
1999). The traditions are followed by most rural
and some poor urban women in Chiang Mai. This
was also observed by Muecke (1976) in her study of
childbirth more than two decades ago, and in a
recent study by Liamputtong et al. (2002). Yimyam
et al. (1999) have also observed these differences
in their study of breast feeding among working
mothers in northern Thailand. In addition, some
traditional practices can constrain women rather
than assist them. For example, a precaution given
to pregnant women not to work too hard to avoid
miscarriage. This would be difficult for some poor
women to avoid, as these activities form part of
their daily routines, and they may not have familial
or a social network to relieve them from the work.
It is, therefore, imperative that differences between
women based on their social backgrounds
need to be taken into account when advising Thai
women, in order to achieve sensitive birthing care
for women.
This study contributes to the published literature
on cross-cultural studies of pregnancy and birth in a
Thai setting. We provide readers with cultural
meanings of pregnancy and birth within a Thai
context that may assist health professionals to
better understand wom