Addressing Barriers for Midwifery Care in Mexico: Interview With Cris Alonso

Luna Maya is a midwife-run birth center in Chiapas, Mexico. This the second part of a two-part edited conversation with its director, Cris Alonso. To read the first part of this interview click here.

Q. What have been some of the primary barriers to realizing your vision for Luna Maya?

I would identify two major barriers:

1. Lack of regulation of midwifery and birth centers: Mexico does not have an open system of midwifery regulation. Currently, only students who graduate from one school (CASA) can access professional certification. Foreign or otherwise trained midwives cannot access certification. Since midwives have been identified as key personnel for strengthening maternal health systems, increasing the breadth of midwifery certification and regulation in Mexico is key to improving both access to maternal health and associated outcomes.
2. Lack of funding for a midwifery model of care in Mexico: Donors clearly are interested in making systemic changes that will affect the quality of care in major institutions. However, the lack of midwives in the system makes it near impossible to study the impact of midwifery on maternal health, and, therefore, garner attention and funding for midwifery care.

Q. What are some surprises you have encountered along the way?

The most exciting surprise was watching how a family planning and birth center turned into a femifocal family health center made up of a large network of providers. These providers not only honor the perinatal period as central to long-term community health, but also accompany women in health care throughout their lifetime.

An unpleasant surprise was a fine of $34,000 by the ministry of health for having birth equipment, but no operating room, in the birth center. The Mexican clinical guidelines state that in order to attend births a clinic must have an operating room. Due to budgetary restrictions, maintaining an operating room was impossible at the time. Births are attended at home and in few cases, when the birth was too fast or the woman lived too far away, at Luna Maya. We are now in a legal battle with the ministry of health regarding the safety and legality of having birth equipment in the center. If we lose the case, Luna Maya will have to cease subsidies and be in serious financial peril.

Q. What are the next steps for Luna Maya?

Expansion! Despite the above situation, we have decided that we have a model that works, the women love it, and our outcomes are extraordinary. We are currently in process of opening a second clinic in Mexico City. In this case we have aligned with a humanized gynecological practice and, funding permitting, will build an operating room in order to function legally and provide care without having to transport to public institutions.

We are also working with Osa Mayor Midwifery school in Tulum to fuse our midwifery-training curriculum and create a multicenter and online midwifery school. The governing NGO of Osa Mayor, Parteras Tradicionales Unidas Tumben Cuxtal, works with professional and traditional midwives as well as a gynecologist. They believe that the Luna Maya model will benefit the community and service provision in Tulum. In addition, a midwife, who interned briefly at Luna Maya, and her sympathetic gynecologist colleague have also approached us to open a Luna Maya in Guadalajara.

It is evident that Luna Maya has garnered respect and an excellent reputation among the humanized birth and midwifery community in Mexico. Midwives and women look to Luna Maya as a reference for implementing a model that honors the reality of women´s life cycles and healthcare decisions.