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Mexico Training Midwives to Prevent Maternal Deaths

Monica Ortiz Uribe - Fronteras Desk
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January 3, 2013

A Visit With a Traditional Midwife in Oaxaca, Mexico (hrhcare)

TLAPA, Guerrero, Mex. - Mexico is re-making its centuries-old tradition of midwifery. These days the majority of babies are born in hospitals, but that hasn't helped reduce the number of maternal deaths. So health officials are now betting a new kind of midwife, one trained in a clinical setting, may be a solution. The southern Mexican state of Guerrero opened a school in August where these midwives are being trained.

Inside a classroom at the school, 27 young women sit up straight in tiny desks and answer their teacher's questions in chorus. Their round brown faces and thick black hair are typical of this mostly indigenous region. Many are descendants of an aging practice - they're the daughters, granddaughters or nieces of traditional midwives. This is the first government-funded public school in Mexico and these women are the freshman class.

America Madrid Simon is a slightly shy 21-year-old who sits near the back of the class.

"When I first told people I was studying midwifery, they laughed at me," she said. "They said that's for grandmothers!'"

As Mexico's public health system has pushed more and more women to give birth in hospitals, it’s created a stigma that midwifery is old fashioned and has no place in modern medicine. As a result, traditional midwives are attending fewer and fewer births. But that strategy hasn’t necessarily worked out for the best.

"In my village there is a small clinic but there are no nurses or doctors there," Madrid said. "To get to the hospital we have to walk an hour and a half to get to the nearest road."

In a different village, 30 minutes from the city of Tlapa, the situation is similar. Tlatquiltzingo is tucked in the mountains of Guerrero off a winding, unpaved road that's subject to flooding in the rainy season. Boney mutts, goats and piglets freely roam the dirt paths. People work in the fields and speak Nahutatl, their native tongue. This used to be the setting where most babies were born.

Babies were received by women like Macrina Martinez, the village midwife in Tlatquiltzingo. She delivered her first set of twins almost 30 years ago. Today she mostly does home visits before and after a baby is born. Most women in childbirth head to the hospital. But in an emergency, poor infrastructure makes it extremely difficult to get there. Even those who arrive in time have no guarantee they'll get optimal care, according to Guadalupe Mainero, the director of Guerrero's new midwifery school.

"What's going on now in Mexico is the majority of the hospitals are oversaturated and so it's a big problem," Mainero said.

Doctors are sometimes overwhelmed by the numbers of normal births, some of which used to happen at home. That leaves them less time to deal with high-risk births. Mexico's maternal mortality rate has remained at about 50 per 100,000 women for the last seven years according to the World Health Organization. By contrast, the United States' maternal mortality rate is about 21 per 100,000 women. In the rural regions of southern Mexico maternal deaths jump to nearly twice the national average.

This is where the midwifery school could help. The students' curriculum marries traditional midwifery with modern medicine. They learn the old arts like massaging bellies with long shawls while also studying gynecology, obstetrics and basic nursing. When they graduate in four years, they'll have a license and be able to work in urban hospitals and rural clinics.

But Mexico's public health system isn't quite ready to embrace these new professional midwives, according to Dr. Dylis Walker, an American obstetrician who has done extensive research in Mexico.

"There's a huge resistance to the idea that a professional midwife could work independently and on an equal setting as a physician," she said. "If you look at the states in which professional midwives are working, there's a period of transition and adjustment in which there's a little bit of friction and conflict. Eventually they reach this point that there's a very mutually beneficial relationship, and in the end the ones who benefit are the women and their babies."

The professional midwives currently working in Mexico have graduated from a private school in San Miguel de Allende, located in the central state of Guanajuato. The federal government passed a law in 2011 that recognizes midwives as part of the public health system. Currently seven of Mexico's 31 states and the federal district of Mexico City employ midwives in clinics and hospitals.

Nationwide reform is a long way ahead. But the students in Guerrero will not give up easily. They know better than anyone the hardships that confront their communities and how they can help. In that way traditions begun long ago will endure.

This story was produced in collaboration with reporter Lilián Lopez and Round Earth Media’s Mexico reporting project.

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