Childbirth and pragmatic midwifery in rural Ghana

Conceptual categories such as traditional, modern, and postmodern do not further our understanding of the empirical situation of midwifery in late 20th-century rural Ghana. Processes of "modernization," it is argued, have not had much impact on the domain of childbirth. And, despite efforts to "medicalize" birth (by the state and the international movement for safe motherhood and child survival), in Anlo-Ewe cultural contexts in the mid-1990s the lineage still controlled most deliveries, with many babies continuing to be born at home. This article provides an in-depth portrait of one midwife, Sena, who practiced in this rural locale--a locale that is marked by increased "professionalization" and competing ideologies of healing and health. Exemplifying what might best be referred to as critical midwifery grounded in pragmatism, Sena mediated, translated, and maneuvered as she involved herself in the imbroglios of birth and as she worked to improve maternal and infant health.