209344 From herbs to episiotomies: Redefining the Mexican "traditional" midwife and her importance in pregnancy care

Sunday, November 8, 2009

Marcela Smid, MA, MS , School of Medicine, University of California - San Franciso, San Francisco, CA
Dolorez Gonzalez, MA , Reproductive Health, Mexican National Institute of Public Health, Cuernavaca, Mexico
Lourdes Campero, MS , Salud Reproductiva, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
Leslie Cragin, CNM, PhD , Department of Ob/Gyn and Reproductive Sciences, UCSF, Menlo Park, CA
Dilys Walker, MD , Salud Reproductiva, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
Objective: To identify the current practices of Mexican traditional midwives (TMs) and to describe the relationship between TMs and the formal healthcare sector

Methods: We conducted 22 individual interviews and four focus groups with a total of 65 TMs in rural, indigenous, peri-urban and urban Mexican communities

Results: Most TMs living in indigenous and marginalized communities primarily provide traditional types of pregnancy care, including soba (massage), acomodamiento (“turning the baby”), and herbal remedies. Often these TMs provide the only culturally, economically and/or geographically accessible pregnancy care available in their communities. TMs working in urban locations and those with higher levels of education have often sought additional training with physicians. These TMs combine traditional care with medicalized practices including blood pressure checks, episiotomies and family planning. They preferentially refer to private physicians and often receive a courtesy fee. All TMs identify increasing access to formal medical care as important to improving care for women in their communities, but all have had negative experiences with public hospital personnel including disrespectful treatment.

Conclusions: TMs continue to play an important role in pregnancy care in Mexico and they recognize the importance of formal medical care. While Mexican TMs have a wide range of training backgrounds, skills and relationships with private physicians, they uniformly describe difficulty working with public hospital physicians and nurses. In Mexico and internationally, public heath officials should improve outreach efforts to local TMs and directly integrate them into the public health care system to improve access to care for pregnant women.

Learning Objectives:
1. Identify the traditional skills and modern medical practices described by rural and urban traditional midwives in Mexico; 2. Describe the interaction of Mexican midwives with public and private health care sectors; 3. Discuss the future direction of Mexican traditional midwifery.

Keywords: Midwifery, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I participated in all aspects of the project including research design, fieldwork, data analysis and write-up.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.