Editor’s note: This article first appeared in Midwifery Today, Issue 58, Summer 2001.
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Identities and Ideologies

I am pleased to share my thoughts about “mamatoto,” as the term reflects a concept of integration and holism with which I heartily agree. Mamatoto (motherbaby in Swahili) represents a profound truth about those we are honored to serve. There is a mother and there is a baby. Two unique DNA matrixes, individual brains, independent heartbeats, marked by separate sets of one-of-a-kind fingerprints on each digit. Roughly half the time, mamatoto is even comprised of discordant genders. Yet at this point they are inseparable, a tight weaving of two souls with mutual needs. Together they are more than the sum of their parts, representing not only themselves in the here and now, but also all the lineage that led up to this point in time and all that will continue onward as a result of this new birth.

In its fullest inclusive concept, mamatoto expands to embrace another necessary intimate party, the devoted father of the baby/ partner of the woman. In its healthy expression, this bonded triad is strongly united, interdependent, freely and fiercely supportive of each other’s welfare. While the needs and intensity of the relationship may fluctuate from day to day, there is an inexorable growing and deepening toward a certain eventuality that will forever change everyone involved. When the time is right, an amazing convergence of energies, emotions, and physicalities leads to an array of breathtaking events. Mamatoto gathers her resources, transcends her duality, and dramatically divides into two separate entities. While the individuality of each of the two becomes evident, there remains a clear cord of connection, even as the physical version of this cord drops away. The father struggles to maintain equilibrium and discern his right place in this transformed union. The spirit of the new family takes shape. This fundamental understanding helps clarify how she is/ they are best served—in a manner where one’s needs are not separate from nor superior to the others’. Extending this understanding even further, different types of needs and wishes are seen as having interconnected and similarly weighted merit. Physical needs are balanced with emotional ones, the spiritual with the mundane, internal with environmental, earthy with ethereal, romantic with practical, and so on. Dare to neglect one area, and other areas inevitably respond in cascading domino fashion. All aspects share importance in contributing to the totality of the experience. It is a way of reality that orchestrates the cacophony of life’s events into an overall harmony, where the best possible outcome derives from taking in and attending to the whole picture with awe and respect.

Welcome to the Machine

Mamatoto/papatoto is also a perspective sharply at odds with the entrenched linear, industrialized framework, which attempts to know and control by separating and compartmentalizing each aspect of a subject, which is itself understood to be separate from the one considering it. “Modern” people commonly assume, without question, that this is how it should be, the right way, and simply how it is. This narrow worldview emerges when one is trained and processed year after year in structured mandatory schooling and lives in a culture that operates according to such a model. In this system, someone else decides what is (or is not) important enough to be studied, then the matters deemed worthy are divided into discrete subjects, segregated into required or elective classification, squeezed into a schedule, presented in random order in little unrelated chunks, sharply divided by buzzers and bells activated by the clock, signaling the need to turn on or off engagement in a given activity upon such command. This format is justified as part of the socialization process designed to prepare one to find a job and function in today’s society,

With this value system prevailing, it was only a matter of time before it came to be applied to the core societal function of childbearing. Through the prism of this lens, the process fractures into components of inseminating, implanting, developing, gestating, engaging, effacing, dilating, pushing, extruding the fetus, expelling the placenta, recovery of the parturient, adaptation of the neonate, providing nutrition, removing elimination, circumcising, vaccinating, meeting developmental milestones, and coming full circle to educating and integrating into the system. To assure that all goes according to plan, there is the requisite testing, monitoring, medicating, managing, draping, anesthetizing, and so on. Few see the danger in such rigid, pedantic dissection… that it all too easily slips into autopsy, as over-eager paring tends to excise the very heart of the subject. Assembly lines were originally developed for the business sector, overseeing product development and manufacturing systems. Now, while many successful technology companies step away from these prototypes to move forward with redesigned, flexible, humanized work environments, delicate biological entities remain shackled to these obsolete engineering models. In many applications, these systems work well for inert objects, but should never have been applied to people in the first place.

The Question too Obvious to Ask

Why doesn’t an industrial system benefit reproducing people if it’s otherwise useful in the production of things? The question sounds foolish because the answer is obvious and already known: people are not things. Yet this system regularly is applied to people, with the stern presumption that they will conform. Of course regardless of the answer, the system is already fully operational and continues to do what it does so well: produce things. Each part of the childbearing process is subject to the interpretation and validation offered by the machines and equipment developed to oversee the process. The system has become self-perpetuating, since it is growing, making a profit, and generating a steady supply of customers. By manufacturing standards, it is working well.

Mamatoto, on the other hand, has particular trouble complying with the system’s expectations of her, as she exists as an amalgam defying procedural fragmentation. Emotions alter her physical biology, and how she feels physically affects her emotions. Her days are shaped by needs and desires scarcely recognizable as her own. Formerly favorite foods incite revulsion, her center of gravity shifts, major priorities change. She loses count of how many times she’s sat on the toilet today. The birth process, which really began imperceptibly many months ago, takes shape more urgently now as niggling little sensations in her back and belly. At this, the peak of her reproductive life cycle, she perceives her world in a timeless, moment-by-moment manner. What matters most are stroking hands, soothing words, loving eyes, trusting hearts. Patience. And pillows. Wealth measured in an abundance of pillows. Warm water, fragrant scents, dim lighting, enchanting rhythms. Cool water brought just in time to her lips. Security. Acceptance. Just as the baby cannot possibly perceive a time of separation, the mother becomes one with sensations that move them ever closer to that event. Hormones raging, muscles alternately taut and slack, sweaty breaths on her loved one’s neck, the air sizzles with energy and musk.

And where is her caregiver in all this? More often than not, standing over her, clipboard in hand, plotting and graphing out her performance to compare it against protocol and policy and Friedman’s curve! The monitor is bleeping away, needles whisking across their printouts, instruments all aligned, the IV dripping in silently, assuring utmost efficiency and a timely delivery.

Say It Isn’t So!

Liberate mamatoto from this oppressive framework. Reserve “the machine” for occasions when it might actually benefit her. Since those instances are indeed rare, mamatoto must never be routinely chained to it. And we must never be her captors.

Where is her caregiver in all this? Breathing along with the rhythm of the room, extending stroking hands, soothing words, patiently watching with loving eyes and a trusting heart. Dimming the lights, lifting the water, arranging the pillows. The caregiver realizes that the energy around her comes from and belongs to everyone present, that some of the sizzle emanates from the caregiver herself. Her own thoughts and intent share in shaping the event just as do the maternal muscles, paternal companionship and the baby’s vitality. She seeks to strengthen paternal confidence and affection, knowing this bolsters maternal happiness and security, which passes along to invigorate and reassure the baby. The baby, in turn, signals its well-being to the caregiver, who rejoices and relaxes, her delight mirrored back to the family. The circuit is complete. When we stop distancing ourselves from our feelings, face our fears, and grant ourselves permission to fully participate in and express genuine love, caring, and connection, the oxytocin flows, and sparks fly.

Perhaps the midwife’s greatest task is to first love and accept diverse aspects of herself so that she can model this for, extend this to, and facilitate this in the families she serves. Not better than or separate from, she joins their intimate team, and all are thoroughly nourished—mind, body, and soul,

Where is the caregiver in all this? The humming, clicking and buzzing fade away. In its place, one hears singing. Someone has turned off the machine.

About Author: Judy Edmunds

Judy Edmunds, CPM, RNC, LM, CH, is a certified professional midwife licensed in the state of Oregon. She has been practicing independently since 1980. Judy is also a registered nutritional consultant and chartered herbalist. As an HIV/AIDS consultant, certified HIV testing counselor and partner notification specialist, she keeps busy researching, developing and teaching disease prevention programs. She also enjoys teaching emergency response techniques such as CPR, Neonatal Resuscitation, First Aid and Advanced Life Support in Obstetrics. She has been certified as an instructor for the American Red Cross, the American Academy of Family Physicians and the American Heart Association. Judy writes in her "spare" time.

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