Rafaela Lopez Juarez decided that if she ever had another baby, she would try to give birth at home with a trusted midwife surrounded by her family. Her first hospital birth was a traumatic experience, and her perspective changed dramatically when she became a professional midwife.
What women want is to be born with respect and dignity, she said. She believes that low-risk deliveries should take place outside the hospital, at home or in special birth centres, where women can decide for themselves how they want to give birth.
At the end of February, Lopez and her family waited for their second child to come home to Xalapa, Mexico, as they watched the bad news of an approaching coronavirus pandemic. She brought Joshua, a healthy boy, home on the 28th. February, the same day Mexico confirmed his first case of Covida-19. Mrs Lopez wonders how the pandemic will affect her work.
About 96 percent of births in Mexico take place in overcrowded and poorly equipped hospitals, where many women report being treated badly or irreverently. The pandemic outbreak has raised fears that pregnant women in hospitals are at risk of contracting the virus, and women’s health advocates in Mexico and around the world have expressed the hope that the crisis will be a catalyst for long-term changes to the system.
The national movement has made some, but uneven, progress in integrating midwives into the Mexican health system. Some authorities claim that well-trained midwives would be of great benefit, especially in rural areas and in small non-surgical clinics across the country. However, so far there has been a lack of political will to put in place the regulations, infrastructure and budgets needed to recruit enough midwives to make a significant difference.
In the first months of the pandemic, anecdotal evidence indicated that obstetrics was growing in the country. Throughout Mexico, midwives are inundated with requests for home births. The Government has proposed to the authorities that alternative health centres be set up exclusively for childbirth, which can be staffed by nurses and midwives.
With the Covida disease outbreak, health authorities across the country have seen a dramatic decline in the number of prenatal consultations and hospital births. At the General Hospital in Acapulco, in the Mexican state of Guerrero, Dr. Juan Carlos Luna, head of the maternal health department, found a 50 percent drop in fertility. With skeleton staff sometimes working in double shifts, doctors and nurses made their living under difficult circumstances. Almost everyone on my team tested positive for the virus at some point, Dr. Luna said.
In the intensive care unit of Covid-19 in Acapulco General doctors treated Maria de Jesús Maroquín Hernández. In the 36th. In the first week of her pregnancy, she suffered from respiratory problems, after which her family took her to the hospital for four hours. Doctors have Mrs. Moroccan isolated while her family waited outside. They saw the undertaker take Covid’s dead patients and feared she’d be next. She was discharged from hospital five days later and quickly gave birth to an emergency Caesarean section in a hospital near her home. She and her husband decided to call their little girl Milagro – a miracle.
In Mexico’s indigenous communities, women have long depended on traditional midwives, who are now becoming even more important. In Guerrero some women gave birth to midwives in special centres for indigenous women called CAMI (Casas de la Mujer Indígena o Afromexicana), where women can also seek help in cases of domestic violence, which, according to CAMI staff, has increased. However, the austerity measures taken in connection with the pandemic have deprived the centres of the necessary funding from the federal government.
Other women have opted for quarantine and are seeking the help of midwives such as Isabel Vicario Natividad, 57, who continues to work even though her health makes her vulnerable to the virus.
As the number of cases of covid 19 in Guerrero increased, health officials reached out to women and midwives in remote areas where maternal and child mortality is potentially high.
24. December 2020, 20:33 p.m. (Eastern time)
If women are too scared to come to our hospitals, we have to find them where they are, says Dr. Rodolfo Orozco, head of Guerrero’s reproductive health department. With the support of several international organizations, her team recently started visiting traditional midwives to give workshops and distribute personal protective equipment.
In the capital Chilpancingo, many women opened the Alameda Obstetrics Centre in December 2017. In the initial phase of the pandemic, the number of births in the centre doubled. In October, Anaeli Rojas Esteban, 27 years old, came to the center after the local hospital did not admit her for two hours. She was pleasantly surprised when she found a place with midwives who gave birth to her in the company of her husband, Jose Luis Morales.
We are especially grateful that they did not open her up, as they did when she was born in hospital, said Mr Morales, referring to the episiotomy, a surgical procedure that is common in hospitals, but which is increasingly seen as unnecessary.
As the Mexican health authorities struggled to contain the spread of the virus, the situation in the country’s capital has once again drawn attention to the dangers and frustrations faced by women.
Health officials in Istapalapa, Mexico City’s most densely populated neighborhood, fled in the spring when the area became the centre of a coronavirus outbreak in the country. The city government has converted several large public hospitals in Iztapalap into treatment facilities for Covid 19 patients, causing thousands of pregnant women to desperately search for alternatives. According to Marisol del Campo Martinez, the director of the clinic, many have resorted to maternity wards such as the one in Simigen, where the number of births has doubled and the number of prenatal visits has quadrupled.
Other pregnant women have joined the group of women who want to give birth at home for safety reasons and to avoid a possibly unnecessary Caesarean section. In Mexico, about 50 percent of babies are delivered by Caesarean section and pregnant women are under pressure from peers, family members and doctors to undergo this procedure.
In July, Nayeli Balderas, aged 30, who lived near Istapalapa, turned to Guadalupe Hernandez Ramirez, an experienced perinatal nurse and president of the Association of Professional Midwives of Mexico. When I started researching the humanization of birth, breastfeeding, etc., I was very interested in the humanization of birth. But when we told our gynecologist about our plan, her whole face changed and she tried to scare us. You’re restless, ma’am. Balderas kept giving birth at home.
Her contractions, when the time comes, are long and getting more and more difficult. Twelve hours later, Mrs Balderas and her husband consulted with Mrs Hernandez and decided to activate their plan B. At 3 o’clock in the morning they rushed to the private clinic of Dr. Fernando Jimenez, an obstetric-gynecologist and colleague of Mrs. Hernandez, where it was decided that a Caesarean section was necessary.
On the other side of Mexico City, Maira Itzel Reyes Ferrer, 26, also explored the possibility of giving birth at home in September and found Maria Del Pilar Gracheda Mejía, a 92-year-old graduate traditional midwife, who worked with her granddaughter Elva Carolina Diaz Ruiz, 37, a registered midwife. They’ve got Mrs. Reyes through a successful home birth.
My family admitted that they were sometimes anxious during childbirth, Reyes said. But in the end, they loved the experience – so much so that my sister is now in midwifery school. She’s already paid and started!
With the onset of winter, Mexico was faced with a second devastating wave of the coronavirus. Hospitals in Mexico City are quickly running out. The public obstetrics and gynaecology centres in question were not yet operational, while the health staff of renowned hospitals such as the National Institute of Perinatology (INPER) worked around the clock.
At the beginning of the pandemic, INPER staff discovered that about a quarter of all hospitalized women had tested positive for the coronavirus. The administration set up a separate unit for Covid 19, and Dr. Isabel Villegas Mota, head of the epidemiology and infectious diseases department of the hospital, was able to provide the staff with the necessary personal protective equipment. Not all frontline soldiers in Mexico are so lucky; the mortality rate of medical personnel in Mexico is one of the highest in the world.
When Greek Denise Espinosa discovered that she was pregnant with twins, she decided to give birth in a renowned private clinic. But she was shocked by the high costs and decided to consult INPER doctors instead. To her surprise, when she was admitted to hospital in November, she tested positive for the virus and was sent to Covid-19, where doctors performed a Caesarean section.
Supporters of motherhood have long argued that the Mexican model of obstetrics should be changed in order to put women at the centre of attention. When it is time for the health authorities to fully assume the role of midwife, they say it is time to argue that thousands of midwives across the country can help relieve the pressure on an overstretched and often suspicious health system, while at the same time providing quality care to women.
The model we have in Mexico is an outdated model, says Dr. David Melendez, technical director of the non-profit organization Committee for Safe Motherhood in Mexico. It’s a model we all lose. Women lose, the country loses, the health system loses and health workers lose. We’re stuck with the wrong model at the worst possible time, in the middle of a global pandemic.
Sunset over the Casa de la Mujer Indigena Nellis Palomo Sanchez in San Luis Acatlan, Guerrero.
Janet Jarman is a Mexican photojournalist and documentary filmmaker who directed the documentary Birth Wars. It’s presented by Redux Pictures.