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Midwives Improve Quality of Care for Mothers in Mexico

Alina D. Bishop Velarde, a midwife in Morelos, Mexico, is seeking to promote the humanization of birth. “It’s something many women in Mexico do not experience during childbirth,” she says. “In this world everything is going so quickly, we forget about this human ingredient.”

The mother of three speaks from her own experience. “When my oldest was born I asked to hold my baby. They told me, no way, you will infect the baby and took her far away. Nowadays we know that skin-to-skin contact is the best thing for baby and mother.” That was 42 years ago, but she says many women in Mexico are still traumatized by childbirth especially in overcrowded public hospitals.

The birth of her second child at a smaller clinic was a little more humane, she recalls, but by the third child she felt empowered to have her baby at home with a traditional midwife. It was a transformative experience that set the course for Bishop Velarde’s midwifery career. She decided to apprentice with the midwife who delivered her baby and shortly began her own midwifery practice.

Bishop Velarde is among the first generation of professional midwives in Mexico. In 1989, while working as a traditional midwife, she was invited to join a pilot midwifery program conducted by Patricia Kay, a midwife from New Mexico, who was instrumental in establishing national core competencies and standards for out-of-hospital midwifery practice as part of the Midwives' Alliance of North America.

Traditional midwifery has a long history in Mexico, however until recent years neither traditional nor professional midwives had clearly defined roles in the healthcare system. More than 95% of deliveries in Mexico are attended by doctors in secondary level hospitals, leading to a saturation of maternity services. This has resulted in situations of mistreatment of women and their infants, including cases of obstetric violence and the excessive medicalization of delivery. Caesarean delivery rates in Mexico are among the highest in the world resulting in harmful consequences for both mother and baby.

“The doctors and nurses have too much work,” says Bishop Velarde. “I don't blame nurses. I don't blame doctors, it's just because there are too few human resources. They opt for a C-section even when it is not medically needed because it can be done in 40 minutes and not take so many hours. My job is to help them understand that midwives can be partners and we can do this work.”

Midwifery has been officially recognized as an important strategy to address maternal mortality by the Mexican government. Since 2015 Bishop Velarde has been working with UNFPA and Ministries of Health in several states to integrate midwifery in public hospitals. Professionalizing midwives and dispelling the misunderstandings that exist among gynecologists, pediatricians and nurses about what midwives can do is part of her mission.

In 2017, the Johnson & Johnson Foundation partnered with UNFPA in Mexico to strengthen the country’s midwifery workforce, starting with addressing gaps in pre-service education. As a result of this partnership, 20 midwifery schools—several in rural areas training students from Indigenous communities—offer newly revised midwifery higher education programs that meet international standards.

Bishop Velarde’s work with UNFPA and the states involves a three-pronged approach. 1) demonstrating the midwifery model and all its competencies; 2) providing pre-service midwifery education; and 3) forming women’s educational circles to raise awareness about midwifery.

While several states have been making strides with support from the government, hospitals have been struggling to provide maternal care while dealing with the COVID-19 crisis. Many local hospitals, like the one that serves her rural community in Morales, have been designated as COVID-19 centers and are sending maternity patients to hospitals more than two hours away.

As a result, more women are turning to midwives during the pandemic. Maternal health advocates like Bishop Velarde are hoping this moment will help health authorities see how midwives can provide quality care to women by treating low-risk pregnancies in out-of-hospital settings and primary care centers and help alleviate pressure in overburdened hospitals.

“Our goal as midwives is to center attention to the physical and emotional needs of the woman giving birth and her child,” says Bishop Velarde. Traditional midwives have been caring for mothers and babies for centuries, she adds, and are essential especially in rural Indigenous communities. “They have an empirical knowledge but often do not have the training to handle emergencies and live too far from medical centers resulting in high maternal mortality rates in rural and Indigenous communities.”

Progress sometimes feels slow but Bishop Velarde is very hopeful midwifery will grow and prosper in Mexico. After 30 years of being a midwife and fighting to be accepted in the hospitals, she is especially encouraged by the difference midwifery education is making in rural communities.

For example, the UNFPA-supported midwifery school in Guerrero has been training Indigenous students who go back and provide culturally appropriate care in their communities. “These professional village midwives speak the language and can care for the women in their communities and take them to the hospital if they are at risk and need more attention. People from the Guerrero health ministry have told me since the school started its work, they have lower maternal mortality rates. Same thing has happened in San Luis Potosi, and other communities.”

Bishop Velarde also runs a doula school in Morelos and is thrilled that many young people are interested in becoming midwives. “When you understand the whole mechanism of birth, not just the anatomical and physiological but also the emotional mechanism, we will attend women differently,” explains Bishop Velarde. “A child born out of aggression fears life, but when a child is born with love, it’s going to be a child that is going to shine.”