Impressions of the Maternal Health Environment From a Mexican Midwife

At the end of August and at the beginning of this month we featured an interview with Cris Alonso, Director of the Luna Maya birth center in Chiapas, Mexico. Here she shares with us her insights on the broader maternal health environment – from obstetric violence to woman-centered care.

Q: What do you believe accounts for the high Maternal Mortality Rate (MMR) in Mexico?

A: There are many aspects: lack of culturally competent care, inaccessibility in rural areas, lack of midwives within the system, over medicalization of birth, massive institutionalization of birth with decreased capacity to attend to the volume of births. Medical training has been proven to be lacking in evidence-based care, which means that women are exposed to unnecessary surgeries, inductions, and interventions that put their lives at risk. In addition, lack of culturally competent care and mistreatment disconnect women from family planning services or from seeking care when a complication arises. Lastly, lack of integration of midwives and obstetric nurses puts excess pressure on gynecologists and residents to attend to two million births a year.

Q: How do you think the concept of Obstetric Violence affects the conversation about Maternal Mortality?

A: Currently in Mexico, the conversation about maternal mortality centers around obstetric violence. A health system that operates without taking into account scientific evidence and that treats women with abuse will incur an increase in mortality and morbidity. The amount of formal complaints has increased tremendously in the last two years as women are becoming more aware of their rights in childbirth. Additionally, high rates of cesareans and interventions are resulting in high and stagnant rates of mortality and morbidity. Currently, federal and state governments, NGOs, and health researchers are taking steps to try to implement programs and policy that will implement humanized birth programs in obstetric institutions.

Q: What changes are needed in the world of women’s health?

A: The Luna Maya model demonstrates that a competent, professional midwife, who is part of her community and provides continuous care throughout the life cycle, impacts maternal mortality. No woman has ever died, or been close to dying of childbirth at Luna Maya. I believe that a femifocal approach to care—a model that listens to women, respects their capacity to integrate health systems and approaches, and is based on trust and confidentiality—encourages women to feel supported by their health care provider and avoid severe morbidity and mortality.