viernes, 19 de octubre de 2007

Midwifery In Mexico- Reflection on a Workshop

I recently attended a talk on midwifery (parteria) organized by Benito Juarez University during a week of women’s rights workshops. Nueve Lunas, an NGO dedicated to promoting and teaching parteria in Oaxaca, and where I am currently working as a volunteer, was asked to present on the topic. The director of the organization, a midwife (partera) herself, and one of the partera students from Nueve Lunas’ school came to discuss parteria with university students and other interested parties. After a half hour of figuring out which room we were supposed to be in, people started to trickle in. We sat in a circle and began with introductions explaining why we had decided to come to the talk and what questions we had about parteria. Having spent a fair about of time talking to parteras and generally being immersed in the partera world-view, I was shocked by several of the responses I heard.

The first woman to speak, a young doctor, explained that she was having a hard time getting women to lie down and stay on their backs with their legs in stirrups during labor and complained that women weren’t letting her check their cervix to see how dilated they were. She wanted to know why people weren’t coming to birth in the clinic like they should. Another woman, the coordinator of the event- who had earlier mentioned that she thought the subject was fascinating- said that she had recently attended a birth of a woman she didn’t know, where the birthing woman refused to lie down and insisted on pulling on a rope suspended from the ceiling while pushing. (A position that facilitates the pushing process because it engages the diaphragm while squatting). The woman telling us this was totally disgusted by the event and was further frustrated when the mother wouldn’t even let her film the birth. She kept repeating that she had found the birth totally ugly (“feo, muy feo”). Another woman explained that she found it irresponsible that a woman would go to a partera who was “supposedly” trained in attending births, when a clinic would have a team of obstetricians and pediatricians working as a team ready to dispense of high quality health care without any of the danger of home births. (Note- she has not had children or the misfortune of having to birth in a clinic.) The second woman agreed, reiterating that birth was dangerous and risky and should be practiced with obstetricians (literal meaning: to stand in front of) rather than parteras (literal meaning of midwife: to be with woman). I wondered why these women had come, what had they wanted to hear? A couple of other people said they were interested in reproductive health and wanted more information. I couldn’t believe what I was hearing! How did people come to believe that hospitals were less dangerous and more humane than birthing with parteras at home? To a large extent, racism and sexism are at the heart of this issue; traditional parteras are normally indigenous women and are stereotyped as superstitious and illiterate. During the 1960`s modern medicine sought to take birth out of the hands of indigenous women parteras and into the hands of white, male-dominated medicine. As late as the 1970`s traditional parteras attended 43% of Mexican births, dwindling to 17% in the mid 1990`s.

And it’s true that there is reason to be concerned about the risks associated with birth. Oaxaca has one of the highest maternal mortality rates in Mexico with 95 maternal deaths per 100,000 whereas the national average is 63.6 per 100,000. But are midwives really to blame for this? A recent study by the Centro de Investigaciones y Estudios Superiores en Antropología Social Pacífico Sur found that 44% of indigenous women who died during childbirth, gave birth alone or attended only by a family member. The study also found that 64% of women who died in childbirth had no prenatal care at all. The lack of prenatal care for pregnant indigenous women in rural areas is consistent with the decline in the number of midwives in rural areas, as midwives grow older and lack replacements.

The comments made during introductions reminded of the views surrounding birth in my own country, where approximately 1% of births are attended by midwives in home-births, whereas in Mexico home births are still somewhat common (17% of births attended by midwives in 1996.) though less and less so. In the US we have eliminated virtually all traces of traditional midwifery while Mexico still has a vibrant, though diminishing tradition of parteria. In the US, when I explained my plans to become a midwife, people ask “but isn’t home-birth dangerous?”

What does the birthing landscape look like in Oaxaca? Of the women who give birth in hospitals, most deliver by cesarean. The public hospitals’ cesarean rate is a whopping 65%; meanwhile the private hospitals are even worse, with an 80% cesarean rate. (The countrywide rate is 40% in Mexico-one of the highest in the world, 30% in the US. The WHO suggests 15% as a healthy norm.) Episiotomies (cutting of the vaginal opening to make more space for the baby to pass) are still regular practice in Mexican hospitals, despite the fact that it has not shown to help prevent fissures, only make them worse. Episiotomies are now long out of fashion for most hospital births in the US. In Mexico, women who give birth in public hospitals must give birth alone, aside from the constant interruptions from hospital staff, as fathers, and birth attendants are prohibited from being present during labor. In most cases women must birth on their backs (the least efficient and often most painful position), are hooked up to lots of beeping monitors[1], and are unable to move about freely or eat and drink anything. Unfortunately, much of these practices prevail in hospital births in the US as well.

During the talk we discussed common practices in hospitals and among parteras, getting at the fundamental differences between parteria and medicine. Parteras believe that women’s bodies work, know how to birth, that the women should be treated with respect and that the mother and baby are guiding the birth; parteras are there for assistance and intervention when necessary. Medicine seeks to fix a problem (in this case: birth) and doctors are taught to intervene to fix the problem- hence the 65-80% cesarean rate. Medicine has an important place in childbirth. That is to handle medical emergencies, not normal births.

After the talk we watched several videos, the first was a short Argentine video showing a typical birth in an Argentine clinic (very similar to a typical birth in a Mexican hospital or clinic.) We were watching a woman’s reproductive rights being violated. It was absolutely awful. The woman’s legs were tied to the stirrups, legs up above her head, gravity working against her. Multiple doctors stood by her vagina and right before the baby’s head appeared, an obstetrician got out his scissors and cut a large gash into her (episiotomy). Moment’s later the baby was born and immediately taken away before the mother got to see it. The baby was then poked, prodded, injected, washed, combed, measured, weighed- all before getting to meet its mother. It was awful to watch. (Watch ¨Callate y Puja¨on YouTube:

)The second video was of a Mexican patera’s birth at home in water. It couldn’t have been more different. It was calm and beautiful. While these two videos showed birth in its extremes, they demonstrate the essential difference between parteria and medicine: respect. I think the talk and videos had a pretty strong impact of the participants, and I believe that some of those women had a better understanding of parteria.


La Partera Profesional : Articulating Identity and Cultural Space for a New Kind of Midwife in Mexico. Medical Anthropology, (Vol 20, Nos. 2/3-4) Dec 2001. By Robbie Davis Floyd

“Oaxaca: Muerte materna en municipios indígenas” by Pedro Matías, El Proceso 03/09/2007

[1] studies have shown that these monitors only increase the amount of medical intervention, there is no benefit in terms of outcome for mother or baby

1 comentario:

Susie dijo...

Hey, I enjoyed reading your reflections on this. I can't imagine what it must have been like to watch those videos..