Traditional midwives: an invaluable resource

Nancue Ñomndaa midwives, respectfully called with the title Nna’, assist to women in the communities during pregnancy and homebirth. These traditional midwives, parteras in Spanish, are the providers of choice for most indigenous women, particularly in far-flung villages where they may be the only skilled practitioners available at the time of delivery.

The culturally safe environment of traditional midwifery contrasts with the cultural distance in government health facilities. Unlike health service staff, traditional midwives speak the local language, share a common worldview with their clients, respect choice of birth position, permit the presence of family members for delivery, and avoid practices that indigenous women find shameful. They also provide culturally valued prenatal care, such as positioning the baby in the mother’s womb, which is the service most frequently requested of midwives, even from women who deliver with doctors.

Quite tellingly, Nancue Ñomndaa midwives produce birth outcomes no more harmful to mothers and newborns than the Mexican health system provides. Our 2008 baseline survey revealed that birth complications such as perineal tears were less frequent in traditional midwife-assisted births (12%) compared to births assisted by doctors (15%), with lower infections of wounds (14% compared to 19% with doctors).

Moreover, indigenous midwives were a critical and undervalued link between traditional and biomedical care: women were seven times more likely to have gone for prenatal control in government health units if a traditional midwife had told them to do so. Most women and their families accepted midwife advice to deliver in a health care unit, while half of all midwives had personally taken their patients to the hospital.

Intervention to support traditional birth culture

However, our 2008 baseline also showed there has been a decline in traditional midwife-assisted home births over the last decade. This trend was all the more evident among younger women and those who received financial incentives from poverty alleviation programs seeking to put pregnancy and childbirth under medical control. To make matters worse, eighty percent of midwives working in the region were 50 years or older at the time of our survey. As the current midwives get older, training members of the young generation is the only way to continue their traditions. All of the midwives we interviewed said they were willing to teach others to do their work.

Based on the results of the baseline survey, and with community participation, we designed an intervention to support traditional birth culture in Xochis. Traditional midwives requested that we build simple birth centres, where they could train new apprentices, assist pregnant women, and attend births.

They also received logistical support from a community health promoter. Apprentices and promoters were selected through a participatory process. The elderly midwives in intervention sites decided who had the necessary qualifications to be apprentices and suggested candidates from the communities. At the same time, they committed themselves to provide personalised training.

The midwives still conduct household visits, accompanied by their apprentices, as far as their age and health permit. They are paid what their clients can afford, which is often close to nothing. They get together in support groups, and also like being visited to discuss this experience.