One of the most dangerous moments in a woman’s life is giving birth, especially when access to quality medical care is not easily available. In Khmer, the term to give birth is called “ch’long tonle” which means to “cross the river”. The elders use this phrase to describe the dangerous journey of crossing the river, which was oftentimes difficult and dangerous. Some would make it, others would drown. The phrase is appropriate in describing the perilous and uncertain journey of childbirth.
According to UNICEF, Cambodia’s maternal mortality rate is 170 per 100,000 live births (2013). While the rate has improved significantly since 1990 (1,200 per 100,000), it is still one of the highest in the world. The biggest challenge is access to quality medical care and adequately trained medical staff prepared to handle the variety of emergency situations that often complicate delivery.
In remote rural areas it’s even more difficult as the lack of medical training and equipment lead to heavy reliance on the community midwife and traditional practices. Although there are provincial hospitals (and referral hospitals) in rural areas, many births are still conducted at home due to the lack of access, high cost or traditional beliefs. As a result, the midwife plays a vital role in helping the expectant mother along the dangerous journey. The Cambodian Council of Midwives (CCM) are trained and certified by the Ministry of Health. The CCM and NGOs have helped to train midwives across the country, which has helped to lower the maternal mortality rate. However, there are still many communities where access is still difficult and thus traditional care and beliefs are more prevalent.
For most cultures, there are traditional beliefs when a woman is pregnant. In Cambodian culture in particular, special care must be taken to prevent emotional or physical distress to the mother. For example, Khmers traditionally believe that pregnant women should not attend any funerals, visit the home of someone who has recently passed away, or visit someone who had difficulty in childbirth. The belief is to prevent her from emotional distress, as well as prevent bad spirits around her. Many traditional beliefs during pregnancy also concern the size of the baby. For example, pregnant woman should not eat spicy foods, take baths at night or take naps during the day. They believe doing these things would increase the size of the baby making for a difficult delivery.
When it comes to the actual delivery I asked my mother about some traditional beliefs and practices. Since most of her children were born in modern hospitals in Phnom Penh, she told me what she remembered seeing as a child growing up in rural Cambodia in the mid 1940s and 50s. Back then, when a woman is ready to give birth, the men gather and set out thorns (bon’la sa’et) around the outside of the house to ward off any bad spirits and animals who might smell the blood from the mother and new child. Sometimes they would give the woman something special to drink, a type of tea to induce labor (phka raing phnom). When a woman is ready to give birth scissors were were placed under the pillow so that spirits don’t harm the infant or woman. Then the woman begins the difficult process of ch’long tonle.
When a woman crosses the river safely, certain traditional procedures are carried out. For example, the placenta was usually buried in the yard around the house. Then there is the common practice called ‘cha’a plung’, which is essentially “roasting’. After the baby is delivered, the woman lies on a bed while a fire (fueled by wood or charcoal) is lit under her. The practice is believed to help heat the body so that all the blood and bodily fluids flows out of the body faster making for a quicker recovery. When my mother had me in a remote rural community during the Khmer Rouge, my father asked the commune leader if he could collect some wood and cha'a plung for my mother after the delivery. After giving birth to seven children, this was the first time she had ever been "roasted".
Everything after delivery concerns heat. Woman are now encouraged to eat spicy foods and sometimes drink liquor. The liquor is usually served as shots and given to the women (sometimes three times a day for three days). The heat from the spicy food and liquor is once again meant to heat up the body so that the blood flows for better circulation. A hot rock wrapped in cloth was sometimes placed on a woman’s stomach after giving birth to help decrease the swelling, force the excess fluids out and help the woman's uterus to contract. During the healing process, traditional beliefs dictate that a woman should not go outside or be in the daylight for one month following the delivery because she is still weak and her blood is still raw.
These are all old wives tales and these traditional beliefs are practiced less frequently, particularly in urban areas where Cambodia is rapidly developing and access to modern medical care is becoming more prevalent. However, many of the rural and remote communities, where access to quality modern medical care is a challenge at best, and non existent at worse, still rely heavily on these old traditions to help many women through the dangerous journey of ch'long tonle so that they can cross the river safely.