Last month, the Mexican Association of Midwifery (Asociación Mexicana de Partería or AMP) held their first regional forum in Tulum, Mexico with the fitting title of “Mexican Midwifery: Between Resilience and Innovation”.
The forum attracted over 100 diverse participants in this animated gathering that included midwives, students, nurses, doulas, researchers, birth educators, traditional healers and physicians all seeking to celebrate community and discuss current professional hardships, government relations and midwifery training opportunities in Mexico. In addition, government officials from Yucatán and Quintana Roo attended and presented during both days of the forum.
Midwifery has a complex history in Mexico, to say the least. Professional midwifery was developed during the 19th century in response to (the perceived shortcomings of) traditional midwifery. The profession was based strictly on the bio-medical model, rejecting the inherent indigenous identity and knowledge of traditional Mexican midwifery. However, professional midwives’ autonomy was short -lived and by the beginning of the 20th century, maternal care in Mexico was only in the hands of obstetric nurses, gynecologists, and obstetricians.
Two government-recognized professional midwifery schools exist today: the well-known CASA in San Miguel de Allende and the Escuela de Parteras Profesionales del Estado de Guerrero. Midwives continue to be trained in other community-based educational settings as well, such as in Luna Llena in Oaxaca and Luna Maya in Chiapas and Mexico City, where students spend two or more years studying and apprenticing with experienced midwives. However, these educational models are currently unrecognized by the federal government. As such, many midwives in Mexico, both professional and traditional, are in a complicated position where they deliver care without a state-sponsored license.
AMP’s work is guided by a commitment to recognize, protect and honor the living legacy of all midwives in Mexico working to improve maternal health outcomes. It is a young organization, established in 2012, and dedicated to the promotion and oversight of midwifery education and advocacy in Mexico. At the national level, AMP has been working to develop national competencies for midwifery education and, in the long-term, plans to inaugurate a certification process that honors the multi-cultural, pluralistic nature of Mexican midwifery and the diverse educational trajectories. The organization is comprised of one part-time staff member, three external consultants, and the volunteer-based board of directors, who work as midwives in communities around the country.
Although the AMP has organized two previous national forums, this was its first regional forum, which allowed AMP to reach out to regional leaders. The regional forum promoted AMP’s vision of an inclusive association for Mexican midwives—as well as obstetric nurses— and provided the opportunity to reflect on the unique needs of the region. And indeed, inclusion was the guiding force of the two-day meeting, with the themes of pluralism, diversity and mutual respect woven into all activities.
The Forum opened with an open dialogue among a local group of traditional, indigenous midwives participating during which they shared their vision, their practice as midwives, and the ancestral knowledge inherent in their role, as well as the great barriers they face providing services in highly marginalized communities.
Presentations the first day centered on interdisciplinary approaches to maternal care, highlighting ripe opportunities for collaboration between midwives and other health professionals, as well as discussion on scope of practice and referral networks. In the afternoon, professional development workshops covered topics pertinent to both professional and traditional midwifery, including herbalism, sexual education, water birth, Mayan abdominal massage, conscious menstruation and homeopathy.
On the second day, the conversation shifted to focus on education and certification. Lessons learned from models from across the country were presented, including a state-level certification process for traditional midwives in Yucatán, a technical degree in midwifery in Michoacán, and an apprenticeship-based model in Tulum and Mexico City. A panel discussion at the end allowed presenters and audience members alike the opportunity to compare and contrast the models.
The regional forum reaffirmed the AMP commitment to pluralism, diversity, and mutual respect for the role of midwives in the country, both historically and contemporarily. Though improving government regulation of midwives is an uphill battle, soon after the forum, the AMP President was able to negotiate that within Mexico City midwives be allowed to register live births. This was an important win, as previously, midwives could not register the births they attended (due to lack of licensure and recognition as a health care professional) so either 1) they had to find a doctor who would retroactively assume responsibility for the birth and register it under their professional license, or 2) leave the birth unregistered, a common occurrence in Mexico. Though progress is slow, small wins like this move us closer to a well-educated, regulated and licensed midwifery workforce in Mexico.
The dialogue and feedback form the regional forum will also inform the next meeting, a national forum, held November 13 – 14, 2015 in Mexico City, Mexico. This forum will focus on the theme of Integrating Knowledge, Building Community: Today’s Midwifery (Integrando Saberes, Construyendo Comunidad: Partería de Hoy) and providing extensive continuing education opportunities.
If you are interested in becoming a member of AMP please visit http://www.asociacionmexicanadeparteria.org/afiliate/.
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