As one of the most populated countries in the world—and an area with one of the highest cesarean section (c-section) rates—Mexico is poised to make progress in maternal health and set an example for the region and world. Impressive advances have been made in decreasing maternal mortality by 64% in 25 years from 86 deaths per 100,000 births in 1990 to 32 per 100,000 births for 2016* yet this has been accompanied by a dramatic rise in c-section and reports of disrespect and abuse. As Sharon Bissell reported in November of 2017, the MacArthur Foundation has launched an initiative to strengthen professional midwifery in Mexico.
In August of 2017, the Network for Midwifery Centers was created in Mexico. Working with the American Association for Birth Centers (AABC), the European Midwifery Unit Network (MUNet) and the global Goodbirth Network, the Network sought to define midwifery centers, create and apply standards of practice and safety, participate in data collection for quality of care and procurement of evidence around the model and foster collaboration and continued education.
On 18 and 19 January 2018, the Network held an International Best Practices Meeting in Mexico City bringing together 83 people including the World Health Organization (WHO), the Pan-American Health Organization, United Nations Population Fund (UNFPA), the Committee for Safe Motherhood, Federal Ministry of Health, eight State Ministries of Health, academics, midwives, mothers and other grassroots organizations. The purpose of the meeting was to come to agreement on the role of midwifery centers in improving maternal health in Mexico.
Presenters included Frances McConville who shared the WHO antenatal care guidelines for a positive prenatal pregnancy experience for the first time in Mexico. Academic and clinical experts and midwives from AABC, MUNet and the Goodbirth Network presented outcomes and evidence demonstrating that midwifery centers:
- Improve outcomes and protect women from medical interventions, including c-section
- Result in similar outcomes as newborns born in hospitals
- Improve women’s experience of the childbirth process
- Are cost-effective
The federal Ministry of Health presented data showing that nearly 300 professionals are currently providing midwifery services in 16 states in Mexico. This includes obstetric nurses, perinatal nurses, nurses, technical midwives and nursing students. Future challenges include expanding midwifery services at a federal level, securing sufficient funding, ensuring providers are qualified and competent, advancing integration of midwives into the health system and promoting services at primary level.
The spirit of collaboration of the meeting was palpable and historic agreements and consensus were reached, including:
1. Definition of midwifery home (casa de partería). Given that WHO recommends continuity of care in the midwifery model and that birth centers provide sexual and reproductive health throughout the life cycle, participants agreed to utilize the term ‘midwifery center’ as it better reflects the full scope. The definition includes the possibility that sexual and reproductive health care are provided and ensures that the model is based on midwifery.
“A midwifery home is a physical space with the capacity to provide sexual and reproductive health to women and newborns; utilizing the midwifery model of care, in a collaborative environment that ensures access to basic levels of maternal and newborn emergency care, integrated within the health system and the needs of the community.”
2. Regulation: Federal and state authorities committed to working with birth centers and allied groups to propose state regulation for existing birth centers and facilitate their integration into the health system.
3. International collaboration: The federal ministry of health will request support from WHO, UNFPA and the International Confederation of Midwives to develop a plan to integrate midwifery in the long term. Stakeholders identified the initiative in Mexico as an example of maternal health progress for the region and the world.
This meeting was historic because it involved decision makers from leading international agencies as well as Mexican health officials, midwives and mothers themselves agreeing on common standards and a regulatory pathway. Integration of midwifery centers into the health system will contribute to Mexico achieving Sustainable Development Goals and Ministry of Health goals of integrating and expanding midwifery services primary level of care. Midwifery centers will provide training sites for midwives to learn the midwifery model and allow for interprofessional education and collaboration. We hope the meeting will inspire similar meetings at a global scale to recognize midwifery centers as safe, cost-effective and respectful establishments for the provision of high quality midwifery services.
Learn more about strengthening and integrating midwifery into the health care system in Mexico.
*Source: Ministry of Health, Mexico, 2018