The Achievements of Traditional Midwives
by Debbie Díaz Ortiz
© 2009 Midwifery Today, Inc. All rights reserved.
[Editor’s note: This article first appeared in Midwifery Today Issue 91, Autumn 2009.]
Herstory records the name “midwife” from centuries ago for those who started our lineage—the midwives from our villages. So simple.
In 2006 a group of traditional midwives (TM) from Latin America united so that their voices would be heard. This happened because 1) they wanted to maintain their prior title of midwife—although compromising and accepting the name “traditional midwife” to differentiate them from the professional midwife; and 2) despite evidence otherwise, the World Health Organization (WHO) stated in a report that most of them could not be trained to safely assist with birth, among other things. Professional opinion superseded the evidence and led to their exclusion. Midwives from isolated communities mention that they even stopped receiving materials and medications.
The document created by the traditional midwives, “The Traditional Midwife in Our Region” (found at relacahupan.net/ingles.htm), was sent in March 2007 to the International Confederation of Midwives (ICM), WHO, the United Nations Population Fund (UNFPA) and the World Bank. This was timed to go out prior to the March 2007 ICM meeting in Argentina. The intent of this document was to let organizations know, through the midwives’ own voices, that in Latin America they are called “traditional midwife” and not TBA (traditional birth attendant), and to regain the assistance and training that they had once received from these agencies to help reduce risks to childbearing women and their babies.
“The Traditional Midwife in Our Region” was published in Midwifery Today, Issue 82, Summer 2007, and MIDIRS journal.
Since sending this document, traditional midwives have achieved the following:
Traditional midwives became part of the Global Alliance of Nursing and Midwifery (GANM) and were invited to actively participate in a very successful Traditional Midwifery Forum with WHO, International Alliance of Midwifery (IAM), ICM and other organizations and stakeholders to share:
- the practices, title and worldview of the traditional midwives
- evidence of what is needed to protect the programs in their villages
- strategies that work
In the GANM conference a group of traditional midwives signed a petition requesting that WHO remove the part of the document that mentions that training traditional midwives is ineffective (World Health Organization. 2004. Making Pregnancy Safer: The critical role of the skilled attendant. A joint statement by WHO, ICM & the International Federation of Gynaecology and Obstetrics [FIGO]. Department of Reproductive Health and Research. Geneva). In the interim, many individuals who work for these agencies now informally use the name “traditional midwife” or “village midwife,” which the traditional midwives appreciate. GANM serves as a bridge for traditional midwives to WHO.
This year, WHO (World Health Organization) mentioned, through GANM, that they do not expect to meet the objective of improving maternal health through professional care. (WHO works with the United Nations Millennium Campaign, among other themes, to improve maternal health and to reduce child mortality. [Millennium Development Goal #4 and #5 (MDG) 2015.]) Traditional midwives and others on their behalf sent letters regarding how to improve programs and to integrate traditional midwives based on mothers’ needs, evidence, the necessity to improve relations between professionals and traditionals in order to reduce risks, and the social realities of isolated villages. Today key people in WHO are aware of the importance of short courses, in addition to training more professionals; and the traditional midwives hope that they continue to develop these.
While some ICM (International Confederation of Midwives) members agree with the 2007 traditional midwives document mentioned above, their leadership has not endorsed it. In 2007 the only requirement for acceptance of the title “traditional midwife” was signatures from the organizations around the world that acknowledge the traditional midwives. Many midwives and organizations internationally did sign a letter in their favor or directly endorsed the document, which was not enough. Midwives Alliance of North America (MANA) also presented the definition officially to ICM in the Scotland congress but no action was taken on it. (Note that none of this is intended to discount the efforts and successes of ICM in promoting the essential role of midwifery throughout the world.)
It will help traditional midwives to be included in international health programs if they are acknowledged by the international midwives’ community—not as identical to the professional definition, but individually, to work in collaboration, and in a way that is consistent with the weight of evidence. They have an important role not only through centuries of herstory, but in current village culture.
IAM (International Alliance of Midwives) drafted an international definition of “midwife” that includes both professional and traditional midwives. This definition was polished in Cuernavaca by mothers and traditional midwives. Prior to this, Midwifery Today had reunited in a conference setting in Costa Rica more than a hundred traditional midwives.
IAM also participated in a Global Alliance of Nursing and Midwifery (GANM) forum on Traditional Midwifery. In favor of the use of the title “traditional midwife,” they provided evidence of how village health care is further protected by training and gave examples of successful inclusion.
Mirna Amaya, a traditional midwife, and Marina Alzugaray, a US midwife, gave their efforts to the first international congress of traditional midwives in Cuernavaca (where the definition was refined). Traditional Midwives from various countries assisted. The Latin American Alliance of Midwives (ALAPAR) was created and continues to develop.
Traditional midwives had a conference where they wrote a law to secure their jobs and, among other provisions, to attain fair retirement benefits.
Following the example of Brazil, Colombian midwives legalized their association this year and are working on developing a school for traditional midwives.
Other traditional midwives’ associations in Latin America have been established and are working today. Guatemala, Nicaragua, Honduras and other Latin American countries are very active in this process and communicate via the Internet.
A conference in Tulum, Mexico, scheduled for May 2009 and to be hosted by aboriginal midwives from Tumben Cuxtal, was cancelled because of H1N1 virus. It has been rescheduled for December 2009. Key traditional midwives from the region will assist.
Traditional midwives continue to work hard to give their best, on local and international levels. Unfortunately, TMs do not have the benefits available to other professionals. I believe that for any petition to succeed globally, traditional midwives from other continents need to unite—and Latin America is a great example that it can be done. In some parts of the world, poverty is increasing. We cannot expect to meet our health care needs without traditional midwives; and mothers deserve their assistance.
I hope that we can give everyone a chance to live with dignity and happiness in this short life. As Mirna Amay, traditional midwife and President of ALAPAR, mentioned, “We must respect each other; we are all humans in the same level and we all have a space—and there is space for all.”
Debbie Díaz Ortiz is a Certified Professional Midwife. She started learning her trade at an early age, when her grandmother, a healer, told her stories of giving birth to 10 kids at home with the village midwife, who was also a friend and neighbor. In 1986, she began an informal apprenticeship with a traditional midwife, and later apprenticed further with both traditional midwives and professional midwives. She’s practiced as a homebirth midwife in Puerto Rico since 1993, and travels to work with other midwives, especially those from marginal communities. She recently opened a midwifery course in collaboration with colleagues in Puerto Rico, the Argentina School for Community Midwives, Relacahupan and Peace Initiatives. Fittingly, her CPM number is her grandmother’s birth date.
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