Decades of interaction between French medicine and Vietnamese culture affected colonial health care and local traditions in oft en unexpected ways. A plural system of maternity services rooted in both indigenous customs and Western obstetrical science offered Vietnamese women more diverse, flexible, and affordable childbirth assistance. The coexistence of multiple childbirth practices— French, Vietnamese, and Franco-Vietnamese—demonstrated the adaptability and limits of colonial power. Outfitted with technology and the strong determination to fight against infant mortality and morbidity, French-trained midwives succeeded in urban areas but failed to convince rural communities about the benefits of biomedical birth. The hostile attitude of rural people toward Frenchtrained midwives and the new regime of childbirth revealed serious problems in the French medical approach that relied exclusively on Western-educated personnel and the overarching network of maternity clinics. The French underestimation of indigenous culture and its overconfidence in technological and personnel resources explained stagnations in the program of childbirth medicalization in rural Vietnam.

The late 1920s marked a significant change in maternal and infant health care in Vietnam. Faced with the ineffective operation of rural maternity wards and the unpopularity of colonial midwives, the colonial state adopted a more flexible and adaptive strategy, as seen in the integration of rural midwives (bà mụ), the downsizing of the corps of colonial midwives, and the intensification of social welfare and childcare services. Instead of overstretching its medical personnel and resources in the vast territories of Vietnam, the medical establishment now focused on providing hospital birth facilities in the urban and provincial centers while leaving childbirth services in the countryside to certified bà mụ. This plural system of maternity services marked the transfer of power from the French-led system to the Vietnamese-based model owing to governmental budget constraints, limited personnel, and the perseverance of Vietnamese childbirth traditions. As a result, a more localized and affordable form of childbirth assistance emerged in many rural areas of Vietnam that took into account local preferences, the cultural mentality, and the economic situation of the peasantry. The acceptance of Vietnamese midwives and certain aspects of local birthing traditions signified the greater role of indigenous actors and knowledge in negotiating healthcare services for the benefit of the local population.