The Birth of a Collaboration

Editor’s note: This article first appeared in Midwifery Today, Issue 69, Spring 2004.
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Ever since I met two traditional Oaxacan midwives at the 1993 Midwives of North America (MANA) conference in San Francisco, I wanted to visit Oaxaca, Mexico. Ten years later, it happened when Jan Tritten invited me to participate in the 2003 Midwifery Today/ MANA conference in Oaxaca.

I went to the conference with two questions for the midwives: 1) Do you need help? and 2) How can I help? I was eager to see if there was a way to preserve the roots of midwifery in Mexico. The status and evolution of women’s health care today in Latin American countries is affected by health policies, cultural heritage and indigenous vs. technological birth traditions, which have an impact on women’s health outcomes and the current utilization of midwives.

Mexico is one of the few countries in the Americas with a healthy number of traditional midwives. Traditional, indigenous ways of healing and midwifery are abundant in Mexico, especially in Oaxaca. The state of Oaxaca has the greatest number of indigenous populations in Mexico, counting some 16 different pueblos with marginal connections to health services but with a richness of culture and heritage that includes healers and midwives. In Oaxaca, the indigenous healers, including midwives, have organized a formal association with more than 600 members from the mountains, valleys and coastal regions of the state. Oaxacan topography makes it difficult to travel to urban centers, but many midwives came to the Midwifery Today/MANA conference to represent even their far-away, small communities.

They arrived dressed in their traditional long colorful skirts and often had white or black braids trailing down their backs. They had traveled for hours but were ready for conversation. To sit with many of them was heart warming. The indigenous cultures continue to use their tribal languages, rituals, arts, crafts and traditional ways of healing and birthing. The parteras were as ready as I was for a cultural exchange.

Midwifery in Mexico is at the stage of what I call “primary extinction.” Some parteras are doing well, for example, in the state of Morelos and some regions in Oaxaca, while others are losing power quickly. Many areas currently lack midwifery services and the federal government’s push to bring women into the hospitals is working. Television ads recommend medical care, urging women to avoid midwives in a campaign that discounts a rich heritage of traditional midwife healers and the culture of the pueblos.

Low-income women are given 250 pesos per month, an equivalent of $25, as an incentive to leave their communities and birth in hospitals. Some women now use traditional midwifery services for prenatal and postpartum care only—if at all. Women with resources do not get this stipend. Instead, they pay the high price for highly interventive care in Mexico City and other large metropolitan areas for services in hospitals.

Maternal/infant mortality continues to be a problem, even while interventions and cesarean sections are the trend in urban areas. The Mexican government’s attempt to help mothers, infants and low-income families comes at the cost of the extinction of the country’s traditional midwifery skills and knowledge. There is no time to waste.

During the “primary extinction” stage, a reduction of elders, who pass on the knowledge, can happen in a 30-year span. Once the midwives are gone, the art of midwifery and the healing heritage of an entire people are also gone. “Secondary extinction” ensues and the effort to bring back the tradition is much harder to accomplish. What can be done in Oaxaca, where there is a healer midwifery tradition in need of preservation in communities where 80 percent of women utilize their care as they have done for centuries? The parteras need appropriate support and skillful discourse before Mexican midwifery stops breathing altogether.

It is difficult to think about this while Mexico has a greater number of midwives than many other nations. In North America, however, we have already experienced the extinction and revival of midwifery. It has happened in the United States, Canada and other nations, and the result is that when traditional midwifery is gone or constantly struggling, contemporary midwives gasp to survive.

Midwifery and women’s knowledge, our roots, can become so deeply devastated that by the time a woman realizes what has happened and wants to do something about it, she may not be able to rediscover all of herself in an established system that lacks traditional midwifery know-how.

At the conference, the traditional midwife healers from many regional Mexican communities stated that they wanted to continue the ways of the indigenous people. As our conversations with the parteras continued, our vision of a collaborative program, called the Comadres (a female friend, advisor and confidante) Oaxaca Exchange, grew. We developed several goals in collaboration with the Oaxacan midwives and women. We agreed that although the scope of the collaboration may have several areas of interest, the primary goal is the health of women, mother and infants. We wanted to find ways of preserving and promoting traditional healer midwifery arts, while developing services that value midwifery care and integrate medical services.

We gathered together—some of us in midwifery for many years, including Yeshi Sherover Neumann, Elizabeth Davis, Linda Rouda and Suzette Borrous, along with the young apprentice midwives and some traditional midwives, including Doña Hermila Gonzalez and Doña Nieves, who are the beginnings of our midwifery soul— and shared a temezcal, the healing steam bath run by the traditional midwives. In the dark, we gave thanks for birth, women and for being together at last.

We decided that the best possible solution was to help the Mexican midwives with an exchange of support, which is of mutual benefit. We generated visions of a sisterhood of support, a family. The concept is to link women from the U.S., Canada and Europe with women in Oaxaca as a family to meet the goals of the project and to facilitate the creation of a midwifery school.

The Comadres Oaxaca Exchange program consists of three areas of involvement: the Luna Nueva/New Moon project, which is an educational exchange for mutual study, support and growth; the Luna Llena/Full Moon project, which is the development of a midwifery school for and by traditional midwives; and the Media Luna/Half Moon effort to foster systems of cooperation between midwifery healing arts and medical services in a pilot program in the state of Oaxaca.

Luna Nueva/New Moon

Like a new moon, the educational exchange project will bring new energy into the region, giving support to traditional midwives. Visiting exchange students can learn from the parteras. Participants can share information and international research with each other and have the opportunity to become a “Comadres Family,” building a link between Pan American midwives and each of the exchange students. The goal of the exchange is to foster a culturally sensitive program that promotes awareness of Latin American women’s health care needs, resources and services with Oaxaca as the focal point for the effort.

The traditional midwives have established rotations in a variety of midwifery healer care settings, which demonstrate traditional health care services for women and the midwifery profession. Exchange students will be immersed in the language and culture of the hosting midwife healer’s daily life. The elder midwives are deeply connected to the context of the region, its people and its ecology. The utilization of medicinal plants, steam bath ceremonies, prayer and respect for the integral health of the woman, family and community are all part of the domain of traditional midwifery in many regions of Oaxaca. Exchange students will learn to make herbal preparations, use massage techniques from the traditional midwives and even provide hands-on care in a supervised setting. This collaboration will add to the students’ experience and practice of their own midwifery education, while also bringing new energy to and respect for the preservation of the healer midwife tradition in Oaxaca.

The Comadres Oaxaca Exchange program is based on the stated goals of the World Health Organization. The goals are to reduce maternal/infant morbidity and mortality throughout the world, including STD/HIV prevention, by an increase in the utilization of nurses and midwives as providers of women’s health care and by the integration of midwifery and nursing in national women’s health policy, education and care initiatives. In addition, the Comadres program is dedicated to the preservation of the pueblos’s ways with respect to women’s healing, birthing and nursing culture, as the heart of a community.

Many contemporary midwifery education programs in the U.S, Canada and Europe do not cover the realm of traditional midwifery healer knowledge. In Mexico, there are still many traditional midwives to learn from. To take advantage of this fact, consider joining the next rotation.

Luna Llena/Full Moon

Currently, a project for the development of a school based on traditional midwifery in the city of Oaxaca is in the works. The plan came together when many of us (Yeshi, Doña Hermila, Jan Tritten, Enedya Spradlin-Ramos) met with Cristina Galante and Araceli Gil Archundia, the directoras of the proposed Oaxaca Centro Educativo de Mujer y Familia (CEMyF) Midwifery School. CEMyF, an NGO for the education of women and families in Oaxaca, developed the preliminary model. CEMyF has finished a needs assessment and viability study for the community- based school. The response has been positive from the traditional elder midwives, who had been asking for help in recruiting young midwives. Now a younger generation has been identified and is ready to start the midwifery course, which shows that there is still interest in learning midwifery in Mexico.

Midwifery students will meet once a month at the school during their two-year training. The rest of the time, they will study and live in their own pueblos. This model allows students to integrate traditional midwifery art and retain links to their own heritage, while attending an educational system that adds contemporary science competencies. The Comadres Family” concept comes into play once again in this project, where the goal is to form a relationship between the student and midwife mentor. The concept of the family means closer ties to the CEMyF student/ mentor and to the community where they live, in an effort to directly benefit an elder and a young midwife. It also provides the visiting participant with the opportunity to share in the reality of the community and its future.

You are welcome to become a member of a “Comadres Family” by enrolling in the exchange program, or you may support a “Comadres Family” by sponsoring the education of one pueblo midwifery student.

Media Luna/Half Moon

The goal of the Media Luna/Half Moon project is to foster a viable model of collaboration between the established medical system and traditional midwifery. The pilot project is aimed at helping local midwives establish a service that provides care for women, while conserving the integrity of women’s culture and their traditional heritage. The project is a collaboration among the Comadres Exchange, the Commission Nacional para el Desarrollo de los Pueblos Indiginas, CEMyF and Oaxacan midwives and women.

The healer midwife provides a living heritage, with the potential to excel in caring for women in a model where women can have access to services in both the medical and the traditional systems. Technology balanced with appropriate support from the uninterrupted tradition of midwifery and women’s ways of healing represents the type of integrated models that form the basis for evidence-based care and promote long range health in families and communities.

The government’s childbirth initiative, which supports only hospital birth with a stipend, has overlooked the subtle yet powerful influence of traditional indigenous midwifery healers, their contribution to their region and the impact that their disappearance would have on the health of Mexican mothers and babies. We plan to develop care that is acceptable according to the standards provided by the public health agencies, thus allowing women to receive the stipend for being part of the pilot service.

The preservation of traditional midwifery— which has helped women have babies in their own communities, within their families and homes, in their region and language, and within the customs and norms of a pueblo—is of great importance to women’s overall health and the healing heritage of a community. The survival of women’s health traditions and the development of infrastructures that address indigenous women’s long-term health care needs can become increasingly difficult to maintain when women are forced to birth outside of their support systems. It has an impact on each woman, her family and midwifery.

Midwifery healer tradition encompasses a living knowledge that spans hundreds of births from home to home, community to community. It is based on intimate knowledge of women and their families that goes beyond the capacities of clinic or hospital services. The traditional partera is as much a counselor, as a healer and friend who can assist the family with diet, herbology, massage, hygiene and education. Lab tests, health screenings and other such services can be provided by public health nurses in collaboration with regional midwives to offer prenatal, intrapartum and postpartum care that works with women’s traditions and pueblo community to foster healthy pregnancy and childbirth.

The partera want to rejuvenate their current midwifery population and preserve their traditions. They want to carefully maintain their accumulated wisdom. They want to form positive alliances with the medical institutions, while providing midwifery services and culturally appropriate care. Medical systems are important for the health of a community world wide, but the demise of midwifery is a tragedy that need not happen. Let’s preserve midwifery while it is still alive.

Note: To help support the Comadres Oaxaca Exchange, study with a traditional midwife healer, learn Spanish, touch your roots or participate in other aspects of the effort, please contact Marina Alzugaray by emailing midwife@aol.com or calling (305) 744-3370.

About Author: Marina Alzugaray

Marina Alzugaray, MS, LM, CNM, is an international midwifery consultant and speaker with more than 30 years of experience in women’s health care. She received her Master of Science degree from the University of California, San Francisco, where she focused her research on homebirths and birth positions and related maternal-infant outcomes. Marina has facilitated sacred births in homes, hospitals and birth centers. She now offers homebirths and waterbirths in the Florida Keys, where she develops courses and facilitates educational retreats as director of Comadres Institute. Marina is known as a provider of holistic midwifery care; pioneer of waterbirths; developer of the American AquaNatal method, a prenatal water exercise program; and producer of continuing education courses on sacred birthing, women’s health and care that empowers clients. She serves as regional representative to Midwives Alliance of North America (MANA).

Visit www.comadresinstitute.com and www.aquanatal.com for more information. Contact Marina Alzugaray by e-mailing midwife@aol.com or calling (305) 744-3370.

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