Luna Maya is a midwife-run birth center in Chiapas, Mexico. It was created in 2004 through a MacArthur Foundation (MAF) statewide initiative to reduce maternal mortality in Chiapas. Despite many years of interventions and investment, the maternal mortality ratio (MMR) in Chiapas had remained stagnant over the previous 10 years. We talked to Cris Alonso, the director of Luna Maya, to ask her some questions about the center and what it has done for the women of Southern Mexico.
Q. What need did you identify in Mexico that led you to envision and create a birth center?
When the MAF initiative launched, NGOs, government and experts were convened to form a commission to design an inter-institutional strategy to reduce maternal mortality. At the time, access to emergency obstetric and newborn care (EmONC) was the first line intervention in both evidence and practice. I was on the commission and as we designed the proposal and it was evident that there was a lack of creating access to normal birth. With increased access to facility-based delivery in a country where midwives are not part of the health system, without a goal to increase access for normal births, the risk was that medical interventions, cesareans and thus maternal mortality would continuously increase adding obstetric violence to the problem.
It seemed evident that the proposal also needed an expert entity in training community midwives, or TBAs, on safe delivery and to hold the space for normal birth. A logical step therefore was the opening of a midwife-run birth center where traditional and professional midwives could train and where low-risk women could access normal birth and be referred in a timely and safe way in the case of complications.
Here two issues were evident: first, there was need to improve the skills and training of professional midwives and, second, a need to document the safety of midwifery-led care in a state and country where this had barely been done.
The Luna Maya model, therefore, was conceived as a pilot project to demonstrate the efficacy and cultural pertinence of midwifery-led, primary level care units (birth centers) for attending normal birth. This would also provide improved secondary level care as the local hospital would decrease the amount of normal births attended, freeing up resources to attend to high-risk cases in a better way.
Q. Why did you choose Chiapas as the primary place for your intervention?
Chiapas had maintained a consistently high MMR over the last 10 years. Safe motherhood interventions were consistently lacking in cultural competence, and homebirth with traditional midwives remained the norm. It was a logical step to keep birth at home, where women felt safe and comfortable, but to improve the skills and competencies of midwives, while at the same time improving referral networks and access to EmONC.
Q. What experiences led you to the founding of Luna Maya?
In my apprenticeship as a midwife I worked in an urban birth center in Guatemala City, at CASA in San Miguel de Allende in Mexico and in a rural homebirth practice in Louisiana. I was familiar with cultural competence as a pillar of midwifery care and valued continuity of care as a positive health intervention that not only improved outcomes, but also increased maternal satisfaction enormously.
In my public health training I had interned and then consulted with Marie Stopes International, a reproductive health clinic network that provides family planning and post-abortion care. My vision with Luna Maya was to integrate the positive aspects of a birth center with the positive aspects of a family planning center, centering the care on femifocal care throughout the lifetime, knowing that women bond with their midwives and feel comfortable receiving care from them.
Q. What is innovative about Luna Maya’s model of care?
Once open, Luna Maya took an interesting turn. Other family care experts approached us and asked to join the team. Quickly, we also had a pediatric clinic, prenatal yoga, childbirth education, acupuncture, psychotherapy, massage and osteopathy. We, therefore, developed a model where the entire family could access a model that integrated complementary and medical care that also focused on continuity of care.
What is unique about the Luna Maya model is that it honors women´s choices throughout the lifetime. Women had sexual and reproductive needs as well as other wellbeing needs. We also know that women more and more integrate complementary and medical therapies in their care program and it made sense that all providers were working together with the woman to design a health and wellbeing program, which included prenatal care, treatment for an STI, infant illness, etc. By working together, the medical and complementary health providers could be informed of progress and ensure best outcomes. However, Luna Maya puts women at the center of the health care decisions. We provide a plethora of providers and services and the woman can thus chose what best suits her health care values and beliefs. If a woman is central to her health care program she is much more likely to adhere to treatment and attend consultations or therapy.
The Luna Maya model therefore is femifocal in that it expands much further than motherhood. It explores women’s health as something that happens to all women: women who are mothers, lovers, wives, single, lesbian, stressed, infertile, raped, tired, sick, happy, exposed to STIs, deciding whether or not to continue a pregnancy, choosing a family planning method, taking care of children, and who are part of a family system. I believe that this most reflects the reality of health, as part of a system where we take the woman as a central, intelligent agent of decisions and action.
Check back in next week for the second part of this two part interview.