Rafaela López Juárez was determined that if she ever had another child, she would try to give birth at home with a trusted midwife who is surrounded by family. Her first hospital birth had been a traumatic ordeal, and her perspective changed drastically afterwards when she trained as a professional midwife.
“What women want is a birthing experience that is centered on respect and dignity,” she said. She believes low risk births should take place outside of hospitals, at home, or in dedicated birthing centers where women can choose how to give birth.
In late February, Ms. López and her family awaited the arrival of their second child at their home in Xalapa, Mexico as they followed the threatening news of the coronavirus pandemic invading. She gave birth to Joshua, a healthy boy, on February 28, the day Mexico confirmed its first case of Covid-19. Ms. López wondered how the pandemic would affect her job.
About 96 percent of births in Mexico occur in hospitals, which are often overcrowded and poorly equipped. Many women describe being treated badly or disrespectfully. The pandemic outbreak raised concerns that pregnant women in hospitals could be exposed to the virus, and women’s health advocates in Mexico expressed hope around the world that the crisis could become a catalyst for lasting changes to the system.
A national movement has made determined but uneven progress in integrating midwives into Mexico’s public health system. Some authorities argue that well-trained midwives would be of great value, particularly in rural areas, but also in small non-surgical clinics across the country. However, until now there has not been enough political will to provide the regulation, infrastructure and budgets necessary to employ enough midwives to make a significant difference.
In the first few months of the pandemic, there was isolated evidence that midwives were gaining importance in the country. Midwives across Mexico have been inundated with requests for home births. The government encouraged state agencies to set up alternative health centers that focus exclusively on childbirth and could be staffed with nurses and midwives.
As the outbreaks of Covid spread, health officials across the country saw a sharp drop in prenatal consultations and hospital births. At Acapulco General Hospital in the Mexican state of Guerrero, Dr. Juan Carlos Luna, the director of maternal health, found a 50 percent decrease in births. Since skeleton workers sometimes worked in double shifts, doctors and nurses were enforced under difficult conditions. “Almost everyone on my team has tested positive for the virus at some point,” said Dr. Luna.
In the intensive care unit Covid-19 in Acapulco General, doctors treated María de Jesús Maroquín Hernández. She had developed breathing problems in the 36th week of pregnancy and asked her family to drive her to the hospital for four hours. Doctors isolated Ms. Maroquín while her family waited outside as funeral directors carried away the dead Covid patients, worrying that she would be next. She was released five days later and soon gave birth via a caesarean section in a hospital near her home. She and her husband decided to name their little girl Milagro – miracle.
In Mexico’s indigenous communities, women have long relied on traditional midwives, who are becoming even more important today. In Guerrero, some women have given birth to midwives in special indigenous women’s centers called CAMIs (Casas de la Mujer Indígena o Afromexicana), where women can also seek help with domestic violence, which according to CAMI staff has increased. However, austerity measures in connection with the pandemic have deprived the centers of essential funds from the federal government.
Other women have chosen to quarantine themselves in their communities for help from midwives like Isabel Vicario Natividad, 57, who continues to work despite their own health conditions making them vulnerable to the virus.
As Covid-19 cases in Guerrero increased, state health officials reached out to women and midwives in remote areas with potentially high maternal and child mortality rates.
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Apr. 24, 2020, 8:33 am ET
“If the women are too scared to come to our hospitals, we should look for them where they are,” said Dr. Rodolfo Orozco, director of reproductive health in Guerrero. With the support of a handful of international organizations, his team recently started visiting traditional midwives for workshops and handing out personal protective equipment.
In the capital Chilpancingo, many women discovered the Alameda Midwifery Center, which opened in December 2017. In the early stages of the pandemic, the center’s birth rate doubled. In October, Anayeli Rojas Esteban, 27, traveled to the center for two hours after her local hospital was unable to admit her. She was pleasantly surprised to find a place with midwives who actually allowed her to give birth in the company of her husband, José Luis Morales.
“We’re especially grateful that they weren’t cut like they were when they were first born in the hospital,” said Morales, referring to an episiotomy, a surgical procedure that is routine in hospital settings but is increasingly viewed as unnecessary.
While Mexico’s state health authorities battled to contain the virus, the situation in the country’s capital highlighted the dangers and frustrations women felt.
In the spring, health officials in Iztapalapa, Mexico City’s most densely populated neighborhood, got mixed up as the area became the center of the country’s coronavirus outbreak. The city government converted several large public hospitals in Iztapalapa into treatment facilities for Covid-19 patients, leaving thousands of pregnant women desperate for alternatives. According to Marisol del Campo Martínez, the clinic’s manager, many have sought refuge in maternity clinics such as Cimigen, where the number of births doubled and the number of prenatal visits quadrupled.
Other expectant mothers joined the growing number of women seeking a home delivery experience for safety reasons and to avoid potentially unnecessary cesarean sections. In Mexico, around 50 percent of babies are delivered by caesarean section, and pregnant women are pressured by their peers, family members and doctors to perform the procedure.
In July, 30-year-old Nayeli Balderas, who lived near Iztapalapa, reached out to Guadalupe Hernández Ramírez, an experienced perinatal nurse and president of the Association of Professional Midwives in Mexico. “When I started doing research on humanized childbirth, breastfeeding, etc., a whole new world opened up to me,” said Ms. Balderas. “But when we told our gynecologist about our plan, her whole face changed and she tried to scare us.” Undaunted, Mrs. Balderas proceeded with her birth plan.
Their work was long and increasingly difficult. After 12 hours, Ms. Balderas and her husband discussed with Ms. Hernández and decided to activate their plan B. At 3 a.m., they rushed to Dr. Fernando Jiménez, a gynecologist and colleague of Ms. Hernández, where it was decided that a caesarean section was needed.
Across Mexico City, 26-year-old Maira Itzel Reyes Ferrer had also screened home births in September and found María Del Pilar Grajeda Mejía, a 92-year-old certified traditional midwife who works with her granddaughter Elva Carolina Díaz Ruiz, 37 , trained obstetrician. They guided Ms. Reyes through a successful home birth.
“My family admitted that sometimes they were concerned during childbirth,” Ms. Reyes said. “But in the end they loved the experience so much that my sister is now taking a midwifery course. She has already paid and started! “
At the start of winter, Mexico faces a devastating second wave of the coronavirus. The hospitals in Mexico City are quickly running out of space. The much-discussed birth centers run by state midwives have not yet come into being, and medical staff in renowned hospitals such as the National Institute of Perinatology or INPer work around the clock.
At the beginning of the pandemic, INPer employees found that around a quarter of all women admitted to the hospital tested positive for the coronavirus. The administrators set up a separate Covid-19 ward, and Dr. Isabel Villegas Mota, head of the hospital’s epidemiology and infectious diseases department, managed to ensure adequate personal protective equipment for staff. Not all front-line workers in Mexico were so lucky. The Covid-19 death rate for medical workers in Mexico is among the highest in the world.
When Grecia Denise Espinosa learned that she was pregnant with twins, she planned to give birth in a well-known private clinic. But she was shocked at the high cost and decided to see doctors at INPer instead. To her surprise, when she got to the hospital in November, she tested positive for the virus and was sent to the Covid-19 department, where doctors performed a c-section.
Maternal health advocates have long said that Mexico’s model of obstetrics needs to change to focus on women. If ever there was a moment for health officials to dedicate themselves fully to the midwife, now is the time to argue that the thousands of midwives across the country could help ease the pressure on an overburdened and often suspicious healthcare system and provide quality care to women.
“The model we have in Mexico is an outdated model,” said Dr. David Meléndez, technical director of the Safe Motherhood Committee Mexico, a non-profit organization. “It’s a model where we all lose. The women lose, lose the land, and lose the health system and medical staff. We are stuck in the middle of a global pandemic with a bad model at the worst possible moment. “
pictureSunset over the home of indigenous woman Nellys Palomo Sánchez in San Luis Acatlán, Guerrero.
Janet Jarman is a Mexico-based photojournalist and documentary filmmaker and director of the documentary “Birth Wars”. It is represented by Redux Pictures.
