The Power of Words: In honor of all midwives, Midwifery Today does not use the term “traditional birth attendant,” or “TBA.” We do not want to rob anyone who serves birthing women as a midwife of the title “midwife”—because that is what she or he really is.
The reports in this important area of traditional midwives are relevant to all of us and do not necessarily fit in one country. The rights of traditional midwives are being grossly violated around the world. We offer this topic page for a foundational understanding and for updates. The article by Robbie Davis-Floyd will help you understand the basic issues facing traditional midwives. —Jan Tritten
• Anthropological Perspectives on Global Issues in Midwifery—Robbie Davis-Floyd, PhD [June 2000]
• The Achievements of Traditional Midwives—Debbie A. Díaz-Ortiz [September 2011]
• Who Benefits from Training Traditional Midwives?—Ann Davenport 
• IAM Member Spotlight: Beatris Caiza, Ecuador [September 2007]
• Traditional Birth Attendant: Does the Name Carry Honor?—Debbie A. Díaz-Ortiz [July 2006]
• Traditional Midwives Are Midwives [June 2007]
• Luna Llena (Full Moon) in Oaxaca, Mexico [September 2005]
Learn more about Traditional Midwifery in Midwifery Today Issue 91 (Autumn 2009)
Anthropological Perspectives on Global Issues in Midwifery
… According to the international definition, a midwife is one who graduates from a program duly recognized in its jurisdiction. In the developing world, this generally means a two-year government training program. The women who attend these programs are usually young, often fresh out of high school, and have borne no children themselves. They are educated in an urban environment, then sent out to serve in a rural village, where they wear the white coat and expect respect from the townspeople for their professional, educated status. They usually work in the government-built clinic, but for an extra sum of money will sometimes attend a homebirth if they are called. These government clinics are usually underfunded and understaffed, and often the drugs with which they are supposed to be stocked are sold out the back door by clinic staff to compensate for the inadequate salaries they are paid. Recent anthropological ethnographies describe indigenous women in India, Mexico, Tanzania, Papua New Guinea, and elsewhere saying the same thing about the care they receive in these clinics: "They expose you, they shave you, they cut you, they leave you alone and don’t come when you call, and they won’t allow your relatives to be with you." …
Not surprisingly, even though the governments of these countries have embarked on massive programs to bring birth into the clinics and hospitals, many rural women resist, choosing instead to birth at home with a community midwife. Officially labeled "traditional birth attendants" (TBAs) by WHO and UNICEF because they do not meet the international definition of a midwife, these community midwives are usually older women who have given birth several times and who have become midwives by being asked to attend the births of friends and relatives, slowly gaining first-hand experience of birth. Some of them undertake long apprenticeships with experienced community midwives, while others learn simply by attending births. From the point of view of villagers and townsfolk all over the developing world, the biggest difference between community and professional midwives is that community midwives are recognized by their community as midwives, while the professionals are often seen as young and inexperienced women who have to prove their worth to the villagers before they can be trusted.
[Please read the rest of this article here.]
— Robbie Davis-Floyd, PhD
IAM Member Spotlight: Beatris Caiza, Ecuador
Beatris Caiza, represents the Spanish-speaking clinic Jambik Wasi, which is a traditional group of indigenous midwives who practice natural medicine in the cloud mountain forests of the Ecuadorian Amazon. They have been using native natural medicine for prenatal, natal and postnatal care since time immemorial.
Currently, they are trying to raise international support for our traditional midwives clinic in Ecuador, which will serve 33 indigenous communities with full spectrum women's and children's natural health care. They also are trying to preserve traditional natural medicinal knowledge by providing continuous training and educational opportunities for the Indigenous communities in the area. They strongly believe that protecting the endangered habitats of sacred natural medicines is an integral part of the clinic's priorities.
They believe that natural healthy living is a basic right of all peoples; a healthy natural sustainable economy along with traditional knowledge allows people to live a healthy and happy life. They also believe that respect for the rights of all life includes a healthy pregnancy, sacred birth and a magical life on our natural earth, and that knowledgeable midwives are an integral part of the struggle for justice.
Jambik Wasi is very interested to be in contact with like-minded groups who want to preserve traditional knowledge and natural sacred areas. In addition, they are very concerned about the commercialization of medicine and believe that free and natural health is a basic right of all peoples.
— Beatris Caiza
Traditional Birth Attendant: Does the Name Carry Honor?
The use of the phrase “skilled birth attendance” or the acronym TBA [traditional birth attendant] concerns and disturbs me and others I have communicated with in this region of our world and in other informal conversations. Instead, it is more accurate with our history and gentle to our emotions to create a definition for the term traditional midwife for the women who learn with colleagues and/or through experience.
Considering only those who have formal studies to be midwives is to deny the beauty and uniqueness of our history that I and many I have communicated with or read about are so proud of.
Studying history in its depth (my B.A.) we repeatedly see life and learn that in situations where change is attempted by force, converted, [or denied], it just doesn’t happen. On the contrary, whatever is to change stays stronger or because of a noticeable sacrifice naturally, genetically remains in life and/or in our memories. As we have persisted through centuries, our name lives on.
When will all midwives have formal studies? Mostly when poverty ends [in the] continents of the world. When will poverty end? Maybe god has a date. When will midwives in this region of the world be called by other names between their neighbors? Never.
Can we just define the term traditional midwife instead of use TBA for them? Most of them will never know about it, but in respect of their hard work, knowledge and the noble service they offer to women others are so afraid to give service to, we honor them.
It’s all about our name and definitions. It’s a matter that should not pass unnoticed. And, the change should be a democratic decision of many, not of one—a real leader will never ask people to accept their opinion as the last word.
Do the strategies to formalize midwifery work in this region of the world? Really, no, it is an unnecessary battle. It has been so stressful for many who follow midwifery closely, who have seen it for years in other continents. It has caused injury so deep, the wound is so open. Let’s be midwives to our feelings; naturally this will protect, make an international recognition, open a door, go deeper in the importance of our linage, to justly integrate the elegance of our history. Projecting midwifery to the world proudly, in its essence, and, as it is, just exquisitely formidable in its wholeness.
A name carries honor and history.
— Debbie A. Díaz-Ortiz, midwife
Luna Llena (Full Moon)
“Midwives are the inheritors of the pre-Hispanic medicine woman, the spokespersons of the gods, the priestesses of life, the protectors of health, the counselors of couples, the ones who scold, the ones who are not silenced by men, the ones who know the secrets.” (Cristin Galante y Martha Casteñeda, Mujer partera en Oaxaca. Género y salud en el Sureste Mexicano, 1997.)
In rural Mexico, midwives still attend almost 50% of the births, preferred over the doctors because they themselves are women, because they charge less, because they go to the woman’s home, are available, speak the same language and share the same culture and because they treat women with warmth and emotion. Nevertheless, traditional midwives recognize their limitations in intervening in grave situations of obstetric emergency.
Throughout history, indigenous midwives have learned through practicing with other midwives or through their own direct experience and, often, in response to a spiritual calling, dreams or visions. The knowledge and understanding they possess form part of their sociocultural environment, which they share with the women they attend—not only the same language, but also the same concepts of the body, the same values and a shared knowledge of medicinal plants. Midwives are immersed in the same daily lifestyle as the women they attend because they too are mothers and wives. For all these reasons, they enjoy the trust of the woman and her family members.
Luna Llena is a training center for Oaxacan midwives—it is a dream, the possibility that women may live and create their health and health care as a holistic and integral process, on the principle that the manner of birth defines the manner of life, respecting the Great Spirit that gives life as it is expressed in the mother, father, baby, midwife and nature.
This midwifery center opens a forum for a process of formation directed at people with experience in health care and who have special interest and a strong motivation to become midwives—for example, community health promoters, traditional healers, nursing students, daughters of traditional midwives or young people who are apprenticing with another midwife.
This forum is also open to include people who might want to assist with a scholarship sponsored by an institution or private organization. This training for students and young midwives will open doors to a new generation of Mexican midwives with knowledge about local necessities and international standards. The training is framed by a perspective of continuous, extensive learning of high quality that will span the spectrum from learning to application of what has been learned. The educational process will also take account of the many individual processes of the students and community and will stress interrelationships and interchanges between midwives.