Bringing a new life into the world should be a calm, natural experience, not one accompanied by the subtle violence of unnecessary surgery. Because every woman’s birth experience is indelibly stamped into her memory, in my work as a midwife I try to help my patients make outstanding memories.
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Before I started out on a career in midwifery in 2011, I thought that delivery by caesarean section was best for the mother and the baby. That is what I had seen and heard growing up in Guatemala and then saw in Mexico, where caesarean sections are common. While this procedure can save lives, it can also lead to infection, bleeding, complications in future pregnancies, and breathing problems in newborns. I started changing my mind during midwifery school in Mexico. There I learned that natural childbirth is a much better option for most births and became determined to transform the way women in Mexico give birth from an interventional procedure to a natural one in which women are given the voice they deserve. During my año de servicio, my mandatory year of service working as a midwife in a rural town called Revolución, I saw how this approach could succeed.
Revolución is in Chiapas, the southernmost state of Mexico. It is a rural, rugged part of the country with very few health professionals to care for its more than 3 million inhabitants. That may help explain the high rate of maternal deaths, more than 60 per 100,000 live births, which is about four times higher than in the United States and 20 times higher than in Finland and Iceland. But Chiapas also has one of the highest caesarean section rates in Latin America — almost 50 percent — which doesn’t make sense given the shortage of doctors.
Some women brave the two-to three-hour journey from their homes to hospitals or birth centers, where the caesarean section rate is quite high. But many women in Chiapas deliver their babies at home, often with the help of one or more parteras. These are local women who help others in the community during their pregnancies and births. Although these women generally have not had any formal training about how to care for pregnant women or deliver babies — they use the skills they learned from parteras who came before them — many times they are the only and best source of assistance for pregnant women.
Parteras offer advice during pregnancy. They stay with women during labor and birth, encouraging them to move or squat or push as needed. Some prepare medicines from plants to ease or accelerate labor. Above all, they support the women they care for. If a partera is worried that something is not right, she helps a woman go to the hospital.
Part of my job is to deliver babies and to ensure that women who cannot or should not give birth naturally get the best medical care possible. The other part is to teach parteras the additional skills they need to help women have healthy and safe births at home and to recognize situations that require medical attention.
This work is funded by Compañeros en Salud, our name for the USA-based Partners in Health. This organization is working to improve health in Chiapas and other underserved regions in Mexico. In collaboration with the Mexican Ministry of Health, Compañeros en Salud has incorporated the Unidad de Parto Humanizado (Humane Birthing Center) in the town of Angel Albino Corzo. It is home to a pilot program that promotes respectful and culturally appropriate births attended by professional midwives, parteras, nurses, doctors, and other clinicians.
Some pregnant women in the community hear about the center by word of mouth. Others are sent to us by parteras. We work as a team to help women get the care they need, whether it’s routine prenatal care or childbirth or controlling pregnancy-related diabetes or high blood pressure. Since the hospital does not have any surgeons on its staff, women who need a caesarean section must be transferred to a hospital more than three hours away that can perform the procedure.
Helping women avoid unnecessary caesarean sections is work I am proud to do. By observing women in labor and listening to them, I grow more and more convinced that empowering women to have natural births is best for both mother and baby. Of course, it is also important to know when this is not the best option for them.
When we travel to towns far from Angel Albino Corzo, we do not go in without permission and we do not tell the midwives what to do. Instead, we hope to be invited into the community to share information. When a partera learns new things from us, she is almost always very proud of it — this knowledge gives her greater credibility in her community. But we also learn from parteras. One of the most important lessons I have learned from these rural midwives is the importance of truly listening to pregnant women and those in labor.
Parteras are very capable, and they don’t want their work to disappear, taken over by impersonal and possibly uncaring hospitals. At the same time, they are willing to learn new ways to support pregnant women, deliver babies, and identify problems that need urgent medical attention. Like me, the only thing they want is what’s best for their patients.
My grandfather was a medico tradicional, a traditional medicine man. His neighbors often sought him out to fix their injuries and cure their illnesses. Sometimes he also helped women give birth. I often think of him as I work with pregnant women and parteras, certain that a mix of old and new ways is what our community needs right now.
Carolina Menchú is a midwife in Chiapas, Mexico, where she works with Compañeros en Salud. (Helen M. Dájer, a Boston-based certified nurse-midwife, translated the article from Spanish.)
Photographer’s note: In Mexico, obstetric care in public hospitals can be so abusive that a movement for parto humanizado — humanized birth — has taken root in the country. I learned about Carolina Menchú’s work to advance evidence-based, respectful care from one of her professors at Mexico’s first professional midwifery school and wanted to photograph her place in a growing movement to recognize midwifery’s potential to improve maternal health in Mexico.
Alice Proujansky is a documentary photographer covering birth, work, motherhood, and identity. This project was supported by the International Women’s Media Foundation as part of the Adelante Latin America Reporting Initiative.