Recognizing the Problem
Childbirth is often described as the most sacred and spiritually empowering time in a woman’s life. Russian culture has always regarded birth as a very private and special event, attended only by women and surrounded by custom and superstition. In the 1800s, it became clear that traditional practices during childbirth were the main cause of extremely high infant mortality rates and underlay many health problems for women. To correct this national problem, the government began to intervene in the lives of its peasant women with modern medical ideas, initiating a battle between tradition and modern medicine. The mission of the nineteenth century Russian government to introduce peasant women to modern medical care, by replacing traditional midwives with trained professionals, shows how difficult it is to replace trusted traditional practices that have been central to the majority of people for hundreds of years with modern medicine.
Before discussing childbirth practices, it is important to understand how Russian peasant women lived during the 1800s. Women in rural areas of the Russian Empire were part of the peasant population which, before the twentieth century, comprised eighty-seven percent of the nation’s total population (Pushkareva, 220). They led difficult lives, carrying a heavy work load equal to that of a man, working in the household, farmyard, and field. Men fully understood the vital role women played in contributing to the household; one peasant explained to a researcher in 1880, ‘we need a wife and a horse equally’ (Evans, 149). Throughout the nineteenth century, their share of field work increased significantly, as men began to seek non-agricultural work to support the family (Marsh, 113). Pregnancy did not excuse women from working, because their labor contribution was crucial; it was not uncommon for a woman to give birth right in the field. Aside from such exhausting lives, peasant women did not have a good understanding of hygiene. For them, the notion of being clean involved the removal of potentially harmful spiritual and human agents with traditional herbal remedies and spells. The combination of these economic and cultural factors made women, especially those who were pregnant, easily susceptible to illnesses and diseases (Evans, 116). More importantly, women in rural areas of Russia had neither access to nor willingness to be treated by adequate obstetricians with modern medical training, and insisted on relying solely on traditional midwives during childbirth. As a result, during the nineteenth century, Russia had the highest infant mortality rate in Europe (219).
Znakhars--the folk healers
Russian peasants never acknowledged physical or natural causes as sources of illness and relied solely on accepted traditional treatments. For centuries, “the sole medical practitioner in the Russian countryside” was a folk healer, a znakharka. Being a healer was an occupation taken on mostly by women, although there were men healers (znakhars) (Evans, 148). Peasants regarded these “professionals” with the highest respect and honor for their ability to combine everyday skills and supernatural forces to treat people. By following superstitious beliefs, a znakharka provided the remedies that the people believed in and trusted, such as potions, herbal treatments, and spells (55).
Povitukha--a peasant midwife
A peasant midwife, povitukha, was the most known and commonly consulted healer. Not every healer could hold this ‘most honored place in peasant society’ (Evans, 157). In addition to having all the credentials of an ordinary znakharka, a povitukha could only be a woman, usually older, who had to have at least one child; virgins could never be midwives (156). A povitukha was called upon during labor and delivery to provide the mother with practical and religious support, while assisting at birth. Childbirth was not regarded as a medical event, but rather the beginning of life to be accompanied by rituals, prayers, and chants. A peasant midwife could provide all these traditional services, in addition to taking over the household chores for three days after the birth to allow the mother to recuperate and gain strength. All these services from a well-known member of the peasant community were both cheap and available locally and were therefore highly valued, giving the peasant midwives enormous popularity (Ransel, 229).
Unfortunately, the practices of these medically untrained peasant midwives contributed to very high infant mortality rates in Russia and to the poor health of the peasant women. Women usually gave birth either at home or in the “warm, clean, and private” bathhouse, bania (Evans, 51). A midwife assisted the mother in labor and delivery. Although her superstitious and natural remedies for easier birth, alleviation of pain, fast delivery, and other labor-related issues were accepted by the peasants as beneficial and helpful, they often did more harm to the mother and child than good. As Rose L. Glickman notes in Russia’s Women: Accommodation, Resistance, Transformation, povitukhi were known to “stuff rags into the mother’s anus to prevent the baby from coming out the wrong passage, encouraged [the mother] to vomit, made her jump repeatedly from a bench, and hung her upside down by the feet” (Evans, 159). For a fast and painless delivery, smoke from burned purple cockle was directed into the woman’s vagina. If a fetus died before birth, false hellebore and fermented goat’s milk were believed to help expel it from the uterus (55). Hygiene was not a consideration. Midwives often failed to wash their hands before checking cervical dilations; but it was indeed true that the povitukha’s “not very clean hands guided countless millions of babies into this world” (159). These birthing practices often left the mothers and the newborns ill. Their conditions were further worsened by the return to their daily lives where poor housing, hygiene, diet, clothing, and most importantly, lack of adequate obstetric care led to high rates of infection and infant deaths (Ransel, 220). However, even high infant mortality was rationalized by peasant proverbs and sayings, which described it as a “form of population control” (Evans, 131).
Recognizing the Problem
In the 1860s and 1870s, Russia’s medical reformers became anxious to reduce the unnecessary infant and maternal deaths, that resulted from the povitukhi’s incompetence by training rural midwives. It was obvious that modern obstetric care had to be introduced to the peasant population by training midwives to work in cooperation with physicians. By the late 1870s, there were over twenty schools in provincial cities which provided such women with one to two years’ education (Ransel, 220). However, although most midwives were trained with the intention of working in rural areas, ninety percent of them found it more economically beneficial to work in the urban areas, where there was more demand for professional midwives. Working in private practice in the cities offered better working conditions and easier contact with a physician in case of difficult deliveries. Even peasant women who were recruited for training, who made up a very small portion of all those being trained for midwifery, decided to move to the cities and work in private practice after finishing their training programs in the city institutions (225). Moreover, due to limited funding to the organization of obstetric care, the local governments were unable to provide many salaried positions for midwives and therefore failed to redistribute the midwife population after training. In 1905, zemstva, the chief rural government employers, provided only 2,200 midwife positions for the more than 10,000 trained midwives (221). As a result, women in rural areas remained without modern medical care.
It was also clear that the peasant women did not perceive trained midwives as being necessary and were therefore not willing to accept these medical professionals. Childbirth was a private and a sacred act, to be surrounded by traditional customs; but peasants saw medical professionals as “benevolent colonists [and] intruders from a foreign culture” (Evans, 160). Povitukhi, on the other hand, were not strangers; they were attentive, compassionate, and caring members of the peasant society. Physicians became frustrated by competition from these peasant midwives, who had “the implicit trust of their patients” (160). Povitukhi were usually older than the younger trained midwives, who were often unable to prove their medical superiority. In difficult births, when the trained midwives were called upon, they would still need to call for doctor’s help and alone were no more successful than povitukhi. Peasants were therefore reluctant to call upon trained midwives; they had neither trust in them nor were able to afford their services. Therefore, when it came to choosing between a well-known and trusted traditional povitukha and a young, inexperienced trained midwife, who appeared to be no more superior in care than the latter, peasant women continued to turn to the povitukha (Ransel, 228). At the turn of the century, the government still struggled with its failed attempt to provide modern obstetric care for the countryside.
Finally, the physicians noted that to be successful among the peasants, such medical professionals should be introduced who could gain trust and become as popular with the peasant women as the povitukhi were. The problem was not in whom to train, but in providing competent medical professionals. Women trained for one to two years as midwives were not able to provide medical care that was adequate enough to win the trust of the peasant women. In a way, such midwives proved themselves wrong and drove peasant women away from turning to modern medical care every time they were not able to help in difficult births (Ransel, 231). So in the 1890s, provincial governments sought to place those urban women in the countryside who were trained not only as midwives, but as fel’dshers. The fel’dsher had a broad general medical knowledge, usually four years of study, preceded by prior general education. The Medical Soviet had recognized schools with a combined training for a fel’dsher and midwife; and in 1879, a school in Kishinev, allowed such a combined course for the first time. Soon, all medical professionals, male and female, were provided with courses in obstetrics and gynecology (233). A fel’dsher-midwife, therefore, acted as an obstetrician-gynecologist, working in the Russian countryside. By applying her medical knowledge and successfully treating illnesses, a fel’dsher-midwife gradually established her medical superiority as a healer. Finally, a competent medical professional was becoming as popular among the peasantry as the traditional midwife–this was a formula for success (235). By demonstrating their abilities in successfully assisting women at difficult births, fel’dsher-midwives, gradually became more popular among peasant women. Their reputation grew and the personal relationship and confidence important to peasant women at childbirth was soon created. Aside from assisting women at birth, these women doctors were also able to provide care during pregnancy and the post-natal period, thereby reducing infections and illnesses. In this way, modern medical care was slowly introduced to the peasantry, eliminating unnecessary illnesses and deaths among women and babies (234).
The nineteenth-century transition from traditional midwives to modern medical professionals that the Russian peasant population experienced was a slow but worthwhile process. The birthing practices, based on superstition and natural remedies, which peasant midwives used for centuries were detrimental to the health of the mothers and their newborns. Modern physicians strove to eliminate these practices by working with the government to train professional midwives for the rural areas of the Russian Empire. Modern medicine’s fight with traditions proved to be difficult, as medical reformers struggled to establish popularity among the peasantry. At the end, it was the povitukha’s incompetence in difficult births that proved to peasant women that the successful practices of countryside doctor-midwives could be trusted. By establishing such superiority, the Russian government and medical reformers were finally able to provide the majority of Russia’s population with modern obstetric care.
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