Midwifery: An Art of Maya Women

In Mexico’s Yucatán Peninsula, midwifery has traditionally been a thriving practice amongst the Maya peoples. Midwives have had an important place in rural indigenous communities because they primarily have been the ones to deliver babies.[1] However, since the latter half of the twentieth century; the Mexican government has discouraged women from delivering their babies with traditional midwives in favor of medicalized births in hospitals with physicians.[2] Essentially, this practice aids in the erasure of traditional practices and beliefs amongst the Maya, thus leading to the homogenization of Mexican society. Increased urbanization and industrialization have helped to increase access to hospitals and modern medicine as a whole. However, for maternal mortality, this has not necessarily translated to better health outcomes.[3] The UN’s Millennium Development Goals for beyond 2015 includes “Improve Maternal Health” as its fifth target, with that target being divided into two sections, 5. A: “Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio,” and 5. B: “Achieve, by 2015, universal access to reproductive health.”[4] Mexico has made major strides to try and meet that goal through increased access to hospitals. However, increased hospital access does not always translate to better care. For pregnant women, this has meant increased obstetric violence. This term was coined in Venezuela’s ‘Organic Law on the Right of Women to a Life Free of Violence’ in Article 15 of the law and is defined as: “…the appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and to convert the natural processes [of labor] into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.”[5] This is especially an issue for Maya women in the Yucatán region because they are women of an ethnic minority, and frequently, are impoverished.[6] This paper will explore how the increase in medicalization and decrease in midwifery impacts Maya women in the Yucatán peninsula in Mexico, and the importance of traditional midwifery services for Maya women. Additionally, there will be discussion of practices that are utilized by Maya midwives.

Midwifery has been critically important for the Maya peoples, and despite the efforts of the Mexican government, midwives are still central to the lives of women in rural communities. They are the primary method of gynecological and obstetrical care for women in remote areas.[7] Despite not receiving much modern prenatal care, these women still see their midwives throughout their pregnancies prior to delivery. There is a focus on massage to ensure that the baby is in the correct positioning and is not breech, and to ensure the uterus is correctly positioned.[8] Massage to turn a baby into the correct position, known as an external cephalic version, is utilized by physicians and is noted to be successful.[9] Midwives have been revered in Maya communities because they have traditionally been viewed as medical professionals because of their extensive knowledge of medicinal plants and for taking care of pregnant women.[10]

Aside from the traditional knowledge of midwives, many indigenous women prefer to seek prenatal care and deliver their babies with midwives because of the negative experiences associated with state-run hospitals. Frequently, indigenous women are met with long wait times, a lack of cultural awareness, and language barriers.[11] For these reasons, many Maya women would rather deliver their babies at home with a traditional midwife. Many women also prefer to be in the comfort of their own home with more freedom to deliver their babies as they please. Traditionally, Maya midwives assist women in delivering their babies in a vertical position, such as kneeling or squatting, which allows for the force of gravity to help get the baby out.[12] In a traditional hospital setting, this is not the case and women are laying in a bed to deliver their babies.[13]

In the article “Narratives of Responsibility: Maternal Mortality, Reproductive Governance, and Midwifery in Mexico,” Sarah Williams explains that for the Mexican government, maternal mortality is why women should stop seeking midwives and see physicians instead. This is despite data showing that indigenous midwives pose less of a potential risk to maternal mortality than doctors in a hospital setting.[14] Regardless of the Mexican government’s concerns about midwifery, the practice is still important and widely desired by many Maya women. These women trust midwives and seek their expertise because they feel more comfortable with them and to avoid extraneous medical intervention.[15] Overmedicalization is a contributing factor to obstetric violence. Many women in the Yucatán peninsula, and other regions of Mexico, have their wishes ignored and are administered medications and procedures that they did not want. In “Ideal Citizens: The Birthing of State Truths and Fictions in Quintana Roo,” Sarah Williams exemplifies this with the experience of a non-indigenous woman named Eleanora who went to a private hospital in Tulum to deliver her baby. She informed the staff that she did not want Pitocin, yet they gave her an IV drip with Pitocin. She was also given an epidural, which she had a reaction to, and ultimately delivered her baby via Caesarean section. Upon being discharged, Eleanora asked for her hospital documents which indicated that she had an uncomplicated, planned Caesarean section. This erasure of reality helps to improve the look of hospitals in public opinion.

The Mexican government’s attempt to increase births in hospitals is reliant on two primary factors. The first is emphasizing good motherhood. To be a ‘good’ mother is to seek out prenatal care from a physician in a hospital setting and to deliver the baby in a hospital. The second is to diminish the reputation of midwives and midwifery as a practice. The government has emphasized midwifery as an outdated and primitive type of care that should be replaced.[16] This approach has led to administrative oversight of midwifery as a practice that is attempting to change how midwives are allowed to practice. In “Narratives of Responsibility,” Sarah Williams provides a case study of a young woman named Marcela who died from postpartum hemorrhage and her doctor was later found to not have been trained as a gynecologist despite being in good standing with the College of Obstetrics and Gynecology. After her death, traditional midwives registered with and known to the Ministry of Health in Quintana Roo were given new protocols aimed at reducing the maternal mortality rate. The explanation provided to the midwives was that Marcela’s and several other women’s deaths could have been linked to them having received prenatal care from a traditional midwife despite all of the deaths occurring in a hospital under the care of a doctor.[17] By linking these women’s deaths to the prenatal care of a traditional midwife, the government avoids having to explain and analyze the problems in practice occurring in state-run hospitals, while simultaneously showcasing efforts to increase access to hospitals because of issues with midwifery. Yet, this does a disservice to Maya and other rural and impoverished women. Poor administrative policies that do not address the root causes of maternal mortality will not increase health outcomes. Additionally, this could further restrict access to quality healthcare if traditional midwifery were to be further diminished. Many women would be forced to travel far for prenatal care and to deliver their babies in overrun and underfunded hospitals, which leads to medical negligence as in the case of Marcela. [18]

Midwifery for the Maya peoples in the Yucatán region is an important aspect of their communities. Midwives are renowned and revered for their work. They are also important for healthcare access. However, the Mexican government has attempted to diminish the role of the traditional midwife through overregulation and encouraging women to seek care from doctors in hospitals. This has not led to better health outcomes for women. Instead, women have been forced to travel far to endure obstetric violence and medical malpractice in overrun and underfunded hospitals. A better option for the Mexican government would be to recruit midwives and train them in sterile techniques and allow the midwives to practice in their villages. This could allow Maya women to have better access to care, improve health outcomes, and decrease the load on hospitals.